Provider Demographics
NPI:1063612372
Name:NEW MEXICO PARENT & CHILD RESOURCES, INC.
Entity type:Organization
Organization Name:NEW MEXICO PARENT & CHILD RESOURCES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DESIDERIO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC
Authorized Official - Phone:505-268-4973
Mailing Address - Street 1:3500 INDIAN SCHOOL RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-1143
Mailing Address - Country:US
Mailing Address - Phone:505-268-4973
Mailing Address - Fax:505-268-5056
Practice Address - Street 1:3500 INDIAN SCHOOL RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-1143
Practice Address - Country:US
Practice Address - Phone:505-268-4973
Practice Address - Fax:505-268-5056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMI1211Medicaid