Robert Ericson, PHD

Primary specialty

Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X

License

239 Issued in NM

Legal business name

ROBERT ERICSON, PHD

Practice address

6463 4TH St NW
Suite C
Los Ranchos de Albuquerque, NM 87107-5810

Phone

(505) 344-9500

Fax

(505) 342-1084

NPI assigned

Dec 12, 2007

Last updated

Aug 5, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Robert Charles Ericson, PHDNPI 1275547440

Title

President

Phone

(505) 242-6672

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Robert Charles Ericson, PHD

  • Psychologist
  • Los Ranchos de Albuquerque, NM
  • NPI 1275547440
  NPD (past) Authorized official

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

{
    "created_epoch": "1197417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217894400000",
    "number": "1700069796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6463 4TH ST NW",
            "address_2": "SUITE C",
            "city": "LOS RANCHOS DE ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871075810",
            "telephone_number": "505-344-9500",
            "fax_number": "505-342-1084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6463 4TH ST NW",
            "address_2": "SUITE C",
            "city": "LOS RANCHOS DE ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871075810",
            "telephone_number": "505-344-9500",
            "fax_number": "505-342-1084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT ERICSON, PHD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-12",
        "last_updated": "2008-08-05",
        "status": "A",
        "authorized_official_last_name": "ERICSON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "505-242-6672",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "NM",
            "license": "239",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "NM00N206",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "N8396",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vanessa M Gutierrez, OT
• Katelin Alexandra Kelly-Thomas
• Michael Curtis Letsky
• Dessie Montoya-Soto, M.S. CCC-SLP
• Eligio Roberto Padilla, PH.D.
• Minerva Santana, M.A.,CCC-SLP
• Tansy M. Briggs, Dom, L.L.C.
• Trailhead Pelvic & Visceral Physical Therapy LLC
• Berna Tuncel Jove Colon, PHARMACIST
• Claudia Welch, DOM

• Cognitive & Behavioral Psychologist in Los Ranchos de Albuquerque, NM
• Providers in Los Ranchos de Albuquerque, NM by specialty
• Cognitive & Behavioral Psychologist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2008; 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.