Organization
BERNALILLO COUNTY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TOM SWISSTACK (DIRECTOR)
(505) 468-7122
Entity
Organization
Contact information
Practice address
5100 2ND STREET NW, ALBUQUERQUE, NM 87107
(505) 468-7216
(505) 468-9917
Mailing address
5100 2ND STREET NW, ALBUQUERQUE, NM 87107
(505) 468-7216
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
671
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
N5927
—
NM
Enumeration date
10/18/2010
Last updated
10/18/2010
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