Provider Demographics
NPI:1487375234
Name:COCKRUM, RAMIYAH
Entity type:Individual
Prefix:
First Name:RAMIYAH
Middle Name:
Last Name:COCKRUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 66375
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87193-6375
Mailing Address - Country:US
Mailing Address - Phone:505-492-5891
Mailing Address - Fax:
Practice Address - Street 1:100 NOBLE LN
Practice Address - Street 2:
Practice Address - City:CORRALES
Practice Address - State:NM
Practice Address - Zip Code:87048-7704
Practice Address - Country:US
Practice Address - Phone:505-492-5891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRBT-22-230091106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician