Provider Demographics
NPI:1043934862
Name:REESE, NAEEMAH NICOLE (P-LMSW)
Entity Type:Individual
Prefix:
First Name:NAEEMAH
Middle Name:NICOLE
Last Name:REESE
Suffix:
Gender:F
Credentials:P-LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 S PLAINS PARK DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88203-2517
Mailing Address - Country:US
Mailing Address - Phone:575-317-6119
Mailing Address - Fax:
Practice Address - Street 1:100 N LINCOLN STREET
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:NM
Practice Address - Zip Code:88230-0159
Practice Address - Country:US
Practice Address - Phone:575-734-5420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2022-0446104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker