Active NPI
Santa Fe Psychology, LLC
- Clinical Child & Adolescent Psychologist
- Santa Fe, NM
National Provider Identifier
1962810150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- Legal business name
- SANTA FE PSYCHOLOGY, LLC
- Practice address
- 2204 Brothers Rd
Suite B
Santa Fe, NM 87505-6975 - Phone
- (505) 795-5566
- Fax
- (505) 998-1362
- NPI assigned
- Jul 31, 2014
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Brooke Roberts, PSYD
- Title
- Owner
- Phone
- (505) 795-5566
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | Primary |
Addresses
Primary practice location
2204 Brothers Rd
Suite B
Santa Fe, NM 87505-6975
Mailing address
2204 Brothers Rd
Suite B
Santa Fe, NM 87505-6975
Phone (505) 795-5566
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NM
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160115001612 | NM | Part B Supplier - Clinic/Group Practice | 0547563058 |
Receives reassigned benefits from 10 practitioners Practice locations: Santa Fe, NM |
National Provider Directory
National Provider DirectoryLocations
2204 Brothers Rd
Ste B
Santa Fe, NM 87505
Phone (505) 699-3681
Practitioners & affiliated clinicians
Practitioners 10
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1406764800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1408060800000",
"number": "1962810150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2204 BROTHERS RD",
"address_2": "SUITE B",
"city": "SANTA FE",
"state": "NM",
"postal_code": "875056975",
"telephone_number": "505-795-5566",
"fax_number": "505-998-1362"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2204 BROTHERS RD",
"address_2": "SUITE B",
"city": "SANTA FE",
"state": "NM",
"postal_code": "875056975",
"telephone_number": "505-795-5566",
"fax_number": "505-998-1362"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SANTA FE PSYCHOLOGY, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2014-07-31",
"last_updated": "2014-08-15",
"status": "A",
"authorized_official_last_name": "ROBERTS",
"authorized_official_first_name": "BROOKE",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "505-795-5566",
"authorized_official_credential": "PSYD"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Fe, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.