Provider Demographics
NPI:1508233594
Name:TENORIO, JENNIFER (CPSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:TENORIO
Suffix:
Gender:F
Credentials:CPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 SUNRISE RD
Mailing Address - Street 2:
Mailing Address - City:SAN FELIPE PB
Mailing Address - State:NM
Mailing Address - Zip Code:87001-8019
Mailing Address - Country:US
Mailing Address - Phone:505-639-9928
Mailing Address - Fax:
Practice Address - Street 1:176 SUNRISE RD
Practice Address - Street 2:
Practice Address - City:SAN FELIPE PB
Practice Address - State:NM
Practice Address - Zip Code:87001-8019
Practice Address - Country:US
Practice Address - Phone:505-639-9928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM432175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM432OtherCERTIFIED PEER SUPPORT WORKER