Provider Demographics
NPI:1033424312
Name:JACINTO, IRIS (LISW)
Entity Type:Individual
Prefix:MS
First Name:IRIS
Middle Name:
Last Name:JACINTO
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 11TH ST NW
Mailing Address - Street 2:#1
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2961
Mailing Address - Country:US
Mailing Address - Phone:505-934-5138
Mailing Address - Fax:505-255-1101
Practice Address - Street 1:619 SAN MATEO BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1432
Practice Address - Country:US
Practice Address - Phone:505-255-1101
Practice Address - Fax:505-255-1101
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-070621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical