NPIMap

Organization Active NPI

Santa Fe Psychology, LLC

  • Clinical Child & Adolescent Psychologist
  • Santa Fe, NM
National Provider Identifier
1962810150
Registry record updated Aug 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
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
Last updated
Aug 15, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2014

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

Authorized official

Name
Brooke Roberts, PSYDNPI 1558649517
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)CodeLicenseStatePrimary
Clinical Child & Adolescent PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 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 IDStateProvider typePAC IDDetails
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 Directory

Practitioners & affiliated clinicians

Practitioners 10

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.

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.

Verify at the official NPI Registry.