Individual
MARY J SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SCHOOL PSYCHOLOGIST
Contact information
Practice address
1200 MICHIGAN ST. SOCORRO HIGH SCHOOL, SOCORRO, NM 87801
(575) 838-3112
Mailing address
1200 MICHIGAN ST. SOCORRO HIGH SCHOOL, SOCORRO, NM 87801
(575) 838-3112
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
400521
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
400521
—
NM
Enumeration date
09/01/2020
Last updated
10/26/2023
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