| Rio Grande Neuroscience Llc | |
|
600 Central Ave Se Suite 221 Albuquerque NM 87102-3656 | |
| (505) 345-9288 | |
| (505) 212-0359 |
| Full Name | Rio Grande Neuroscience Llc |
|---|---|
| Speciality | Psychologist |
| Location | 600 Central Ave Se, Albuquerque, New Mexico |
| Authorized Official Name and Position | Jill Ryan (OWNER) |
| Authorized Official Contact | 5054120545 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rio Grande Neuroscience Llc 600 Central Ave Se Suite 221 Albuquerque NM 87102-3656 Ph: (505) 345-9288 | Rio Grande Neuroscience Llc 600 Central Ave Se Suite 221 Albuquerque NM 87102-3656 Ph: (505) 345-9288 |
| NPI Number | 1598142762 |
|---|---|
| Provider Enumeration Date | 04/27/2015 |
| Last Update Date | 05/22/2015 |
| Medicare PECOS PAC ID | 3072820117 |
|---|---|
| Medicare Enrollment ID | O20160121001361 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598142762 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 1147 (New Mexico) | Primary |
| Provider Name | Jill Ryan |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1184939027 PECOS PAC ID: 7113042631 Enrollment ID: I20100921000243 |
| Provider Name | Carol E Watts |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386022762 PECOS PAC ID: 4385947514 Enrollment ID: I20160122000304 |
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