Provider Demographics
NPI:1972965978
Name:ADOBE PSYCHOLOGICAL SERVICES PA
Entity type:Organization
Organization Name:ADOBE PSYCHOLOGICAL SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEIM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, ABPP
Authorized Official - Phone:505-585-4331
Mailing Address - Street 1:PO BOX 35128
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87176-5128
Mailing Address - Country:US
Mailing Address - Phone:505-585-4331
Mailing Address - Fax:
Practice Address - Street 1:1400 CARLISLE BLVD NE
Practice Address - Street 2:SUITE 1
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-5658
Practice Address - Country:US
Practice Address - Phone:505-585-4331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-28
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0987251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health