Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | OT3529 | NM |
NPI | 1750848966 |
---|---|
Provider Name | Rachel E Goldman |
First Address | Albuquerque, NM 87106-2219 |
Second Address | Albuquerque, NM 87106-2219 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2019 |
Last Update Date | 23/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14409638 | CAQH (01) | |
OT3529 | LICENSE NUMBER (01) | NM |