Provider Demographics
NPI:1780765990
Name:MAES, WAYNE ROWAN (PHD)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:ROWAN
Last Name:MAES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 531
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-0531
Mailing Address - Country:US
Mailing Address - Phone:505-898-5662
Mailing Address - Fax:505-898-5890
Practice Address - Street 1:4813 CORRALES RD.
Practice Address - Street 2:
Practice Address - City:CORRALES
Practice Address - State:NM
Practice Address - Zip Code:87048-0531
Practice Address - Country:US
Practice Address - Phone:505-898-5662
Practice Address - Fax:505-898-5890
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM266103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00NL86OtherBC/BS
NM59651OtherPRESBYTERIAN HEALTH PLAN
NMN8313Medicaid