Organization
MEDITELECARE OF NEW MEXICO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA GODFREY (CREDENTIALING & ENROLLMENT MANAGER)
(860) 398-6441
Entity
Organization
Contact information
Practice address
206 S CORONADO AVE, ESPANOLA, NM 87532-2792
(860) 788-6404
Mailing address
PO BOX 1595, MIDDLETOWN, CT 06457-8095
(860) 788-6404
(860) 829-0495
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
2084P0805X
Geriatric Psychiatry Physician
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
06/28/2019
Last updated
05/05/2025
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