| Meditelecare Of New Mexico, Llc | |
|
206 S Coronado Ave Espanola NM 87532-2792 | |
| (860) 788-6404 | |
| Not Available |
| Full Name | Meditelecare Of New Mexico, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 206 S Coronado Ave, Espanola, New Mexico |
| Authorized Official Name and Position | Andrea Godfrey (CREDENTIALING & ENROLLMENT MANAGER) |
| Authorized Official Contact | 8603986441 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Meditelecare Of New Mexico, Llc Po Box 1595 Middletown CT 06457-8095 Ph: (860) 788-6404 | Meditelecare Of New Mexico, Llc 206 S Coronado Ave Espanola NM 87532-2792 Ph: (860) 788-6404 |
| NPI Number | 1629639729 |
|---|---|
| Provider Enumeration Date | 06/28/2019 |
| Last Update Date | 05/05/2025 |
| Certification Date | 05/05/2025 |
| Medicare PECOS PAC ID | 1254668122 |
|---|---|
| Medicare Enrollment ID | O20190815000690 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629639729 | NPI | - | NPPES |
| Provider Name | Keith B Haynie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033355284 PECOS PAC ID: 9436216124 Enrollment ID: I20090325000104 |
| Provider Name | Minda Brown Jaramillo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740495753 PECOS PAC ID: 9638361538 Enrollment ID: I20150819007704 |
| Provider Name | Sandra Jensen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1003975467 PECOS PAC ID: 1456442078 Enrollment ID: I20191017000728 |
| Provider Name | Michael Hewett |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1467472480 PECOS PAC ID: 0244275014 Enrollment ID: I20200122001571 |
| Provider Name | Jane Berger |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831557891 PECOS PAC ID: 6406286954 Enrollment ID: I20200423002038 |
| Provider Name | Amy Susan Debernardi |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1336388198 PECOS PAC ID: 3274964275 Enrollment ID: I20200506003306 |
| Provider Name | Carey Reed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962944926 PECOS PAC ID: 3678841202 Enrollment ID: I20200602001798 |
| Provider Name | Cynthia A Ziemer |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1003039074 PECOS PAC ID: 9335394659 Enrollment ID: I20201106000087 |
| Provider Name | Charlotte Nkwenti |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821687682 PECOS PAC ID: 2860801909 Enrollment ID: I20210503000352 |
| Provider Name | Violet Ashu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881278240 PECOS PAC ID: 0941697072 Enrollment ID: I20220420000806 |
| Provider Name | Ijeoma Uchegbu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336648625 PECOS PAC ID: 9638550155 Enrollment ID: I20220801000928 |
| Provider Name | Glenn Ferguson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1922391994 PECOS PAC ID: 3870771496 Enrollment ID: I20230104001480 |
| Provider Name | Lovette A Ndubisi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225734601 PECOS PAC ID: 3779922042 Enrollment ID: I20240419000017 |
| Provider Name | Rebecca Price |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871224139 PECOS PAC ID: 8325411630 Enrollment ID: I20241021004492 |
| Provider Name | Irena Tsapelas |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1609464460 PECOS PAC ID: 3274946496 Enrollment ID: I20241126001341 |
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