Basic Information
| Provider Information | |||||||||
| NPI: | 1588288450 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SENA | ||||||||
| FirstName: | ISABELLE | ||||||||
| MiddleName: | REBECCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14301 ARCADIA RD NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871232400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059679339 | ||||||||
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| Practice Location | |||||||||
| Address1: | 707 BROADWAY BLVD NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871022360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052680701 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2020 | ||||||||
| LastUpdateDate: | 09/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 104100000X | X-11497 | NM | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.