Provider Demographics
NPI:1215374855
Name:PEANUT BUTTER AND JELLY FAMILY SERVICES
Entity Type:Organization
Organization Name:PEANUT BUTTER AND JELLY FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TEACHER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVATO
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:505-944-7224
Mailing Address - Street 1:209 SAN PABLO ST SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-3103
Mailing Address - Country:US
Mailing Address - Phone:505-944-7224
Mailing Address - Fax:505-944-7229
Practice Address - Street 1:209 SAN PABLO ST SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-3103
Practice Address - Country:US
Practice Address - Phone:505-944-7224
Practice Address - Fax:505-944-7229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM154065252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency