Doctor Name: | DR. ROSELI CAVALCANTE |
NPI Number: | 1114214558 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PHD |
License Number: | 330768 |
Business Practice Address: | 382 Garver Ln Los Alamos, NM - 875443571 |
Business Phone Number: | 5056295955 |
Business Fax Number: | |
Mailing Address: | 382 Garver Ln, LOS ALAMOS |
State: | NM |
Postal Code: | 875443571 |
Phone Number: | 5056295955 |
Fax Number: | |
NPI Enumeration Date: | 07/06/2011 |
NPI Last Update Date: | 07/06/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | 330768 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |