Provider Demographics
NPI:1912144890
Name:ROBERT F. KENNEDY SBHC
Entity Type:Organization
Organization Name:ROBERT F. KENNEDY SBHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SBHC COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:505-923-3031
Mailing Address - Street 1:1511 CENTRAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4408
Mailing Address - Country:US
Mailing Address - Phone:505-923-3031
Mailing Address - Fax:
Practice Address - Street 1:1511 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4408
Practice Address - Country:US
Practice Address - Phone:505-923-3031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM101Y00000X101Y00000X
NM104100000X104100000X
NM251S00000X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1CO1Medicaid