Organization
BRAIN & BODY REHABILITATION PSYCHOTHERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK PEDROTTY PHD (PRESIDENT)
(505) 688-0601
Entity
Organization
Contact information
Practice address
3200 CARLISLE BLVD NE STE 224, ALBUQUERQUE, NM 87110-1664
(505) 688-0601
Mailing address
3029 DELANO PL NE, ALBUQUERQUE, NM 87106-2034
(505) 688-0601
Taxonomy
Speciality
Code
Description
License number
State
103TR0400X
Rehabilitation Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35587008
—
NM
Enumeration date
09/26/2022
Last updated
09/26/2022
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