NPIMap

Organization Active NPI

Bernalillo County

  • Psychologist
  • Albuquerque, NM
National Provider Identifier
1639489206
Registry record updated Oct 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
671 Issued in NM
Legal business name
BERNALILLO COUNTY
Practice address
5100 2ND Street NW
Albuquerque, NM 87107
Phone
(505) 468-7216
Fax
(505) 468-9917
NPI assigned
Oct 18, 2010
Last updated
Oct 18, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tom Swisstack
Title
Director
Phone
(505) 468-7122

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X 671 NM Primary

Addresses

Primary practice location

5100 2ND Street NW
Albuquerque, NM 87107

Mailing address

5100 2ND Street NW
Albuquerque, NM 87107
Phone (505) 468-7216

Other identifiers 1

IdentifierTypeStateIssuer
N5927MedicaidNM

National Provider Directory

National Provider Directory
Tax ID family
Bernalillo County7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1287360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287360000000",
    "number": "1639489206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 2ND STREET NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "87107",
            "telephone_number": "505-468-7216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 2ND STREET NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "87107",
            "telephone_number": "505-468-7216",
            "fax_number": "505-468-9917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BERNALILLO COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-18",
        "last_updated": "2010-10-18",
        "status": "A",
        "authorized_official_last_name": "SWISSTACK",
        "authorized_official_first_name": "TOM",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "505-468-7122"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "NM",
            "license": "671",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "N5927",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.