Provider Demographics
NPI:1952039729
Name:ROMERO, ALYSSA
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:ROMERO
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 1:6330 RIVERSIDE PLAZA LN NW STE 260
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2160
Mailing Address - Country:US
Mailing Address - Phone:505-226-2839
Mailing Address - Fax:505-295-2559
Practice Address - Street 1:6330 RIVERSIDE PLAZA LN NW STE 260
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-2160
Practice Address - Country:US
Practice Address - Phone:505-226-2839
Practice Address - Fax:505-295-2559
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB20241214104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM24171743Medicaid