Provider Demographics
NPI:1992418370
Name:DYNAMIC THERAPY SERVICES OF NORTHERN NEW MEXICO
Entity type:Organization
Organization Name:DYNAMIC THERAPY SERVICES OF NORTHERN NEW MEXICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:505-636-6550
Mailing Address - Street 1:50 VERANO LOOP
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-8827
Mailing Address - Country:US
Mailing Address - Phone:505-629-6853
Mailing Address - Fax:
Practice Address - Street 1:1300 LUISA ST STE 7
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4177
Practice Address - Country:US
Practice Address - Phone:505-636-6550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty