| Robert Ericson, Phd | |
|
6463 4th St Nw Suite C Los Ranchos De Albuquerque NM 87107-5810 | |
| (505) 344-9500 | |
| (505) 342-1084 |
| Full Name | Robert Ericson, Phd |
|---|---|
| Speciality | Psychologist - Cognitive & Behavioral |
| Location | 6463 4th St Nw, Los Ranchos De Albuquerque, New Mexico |
| Authorized Official Name and Position | Robert Charles Ericson (PRESIDENT) |
| Authorized Official Contact | 5052426672 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Robert Ericson, Phd 6463 4th St Nw Suite C Los Ranchos De Albuquerque NM 87107-5810 Ph: (505) 344-9500 | Robert Ericson, Phd 6463 4th St Nw Suite C Los Ranchos De Albuquerque NM 87107-5810 Ph: (505) 344-9500 |
| NPI Number | 1700069796 |
|---|---|
| Provider Enumeration Date | 12/12/2007 |
| Last Update Date | 08/05/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700069796 | NPI | - | NPPES |
| NM00N206 | Other | NM | BLUE CROSS BLUE SHIELD |
| N8396 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TB0200X | Psychologist - Cognitive & Behavioral | 239 (New Mexico) | Primary |