Provider Demographics
NPI:1205366952
Name:JESPERSENCHAVEZ, JESSICA R (LMSW-P)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:JESPERSENCHAVEZ
Suffix:
Gender:F
Credentials:LMSW-P
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:JESPERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4636 CREST AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-4431
Mailing Address - Country:US
Mailing Address - Phone:505-967-2857
Mailing Address - Fax:
Practice Address - Street 1:2001 EL CENTRO FAMILIAR BLVD SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-4592
Practice Address - Country:US
Practice Address - Phone:505-873-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-100711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical