Provider Demographics
NPI:1962738708
Name:RAMOS, TANYA MICHELLE (PHD)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:MICHELLE
Last Name:RAMOS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 LA PLACITA CIR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4008
Mailing Address - Country:US
Mailing Address - Phone:917-825-6901
Mailing Address - Fax:
Practice Address - Street 1:1418 LUISA ST STE 4
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4091
Practice Address - Country:US
Practice Address - Phone:917-825-6901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1144103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist