Organization
ROBERT ERICSON, PHD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT CHARLES ERICSON PHD (PRESIDENT)
(505) 242-6672
Entity
Organization
Contact information
Practice address
6463 4TH ST NW, SUITE C, LOS RANCHOS DE ALBUQUERQUE, NM 87107-5810
(505) 344-9500
(505) 342-1084
Mailing address
6463 4TH ST NW, SUITE C, LOS RANCHOS DE ALBUQUERQUE, NM 87107-5810
(505) 344-9500
(505) 342-1084
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
239
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
N8396
—
NM
01
—
NM00N206
BLUE CROSS BLUE SHIELD
NM
Enumeration date
12/12/2007
Last updated
08/05/2008
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