Provider Demographics
NPI:1275205205
Name:PERRINE, JAHNA MARIE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:JAHNA
Middle Name:MARIE
Last Name:PERRINE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 CARMEL DR
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-3824
Mailing Address - Country:US
Mailing Address - Phone:575-491-4996
Mailing Address - Fax:
Practice Address - Street 1:2820 CARMEL DR
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-3824
Practice Address - Country:US
Practice Address - Phone:575-491-4996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-11311104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker