Provider Demographics
NPI:1063541563
Name:ROMERO, ROSARIO (LISW)
Entity type:Individual
Prefix:
First Name:ROSARIO
Middle Name:
Last Name:ROMERO
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2418 MILES SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-3224
Mailing Address - Country:US
Mailing Address - Phone:505-246-9972
Mailing Address - Fax:505-842-1503
Practice Address - Street 1:2418 MILES SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-3224
Practice Address - Country:US
Practice Address - Phone:505-246-9972
Practice Address - Fax:505-842-1503
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-15591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMQ-8045Medicaid
NMNMB2378Medicare PIN