Provider Demographics
NPI:1821744020
Name:LERMA, AMANDA N
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:N
Last Name:LERMA
Suffix:
Gender:
Credentials:
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 1975
Mailing Address - Street 2:
Mailing Address - City:MESILLA PARK
Mailing Address - State:NM
Mailing Address - Zip Code:88047-1975
Mailing Address - Country:US
Mailing Address - Phone:575-339-9571
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1975
Practice Address - Street 2:
Practice Address - City:MESILLA PARK
Practice Address - State:NM
Practice Address - Zip Code:88047-1975
Practice Address - Country:US
Practice Address - Phone:575-339-9571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-25
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NMRBT-22-200290106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM42406838Medicaid