Provider Demographics
NPI:1043358740
Name:ROUNSVILLE, JARED (LISW)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:ROUNSVILLE
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5732 CIBOLA DR NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-5181
Mailing Address - Country:US
Mailing Address - Phone:505-771-1467
Mailing Address - Fax:
Practice Address - Street 1:4400 PRESIDENTIAL PL NE
Practice Address - Street 2:SUITE C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3442
Practice Address - Country:US
Practice Address - Phone:505-345-3046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI05764104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker