Provider Demographics
NPI:1023222635
Name:SMITH, BARBARA JEANNE (LISW)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:BJ
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW
Mailing Address - Street 1:PO BOX 323
Mailing Address - Street 2:
Mailing Address - City:JARALES
Mailing Address - State:NM
Mailing Address - Zip Code:87023-0323
Mailing Address - Country:US
Mailing Address - Phone:505-859-0814
Mailing Address - Fax:
Practice Address - Street 1:19478 HIGHWAY 314
Practice Address - Street 2:
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002-8223
Practice Address - Country:US
Practice Address - Phone:505-859-0814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-25481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000706378Medicaid