Provider Demographics
NPI:1518038793
Name:WASHINGTON, JIMMY L (LMSW)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:L
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 MOON ST NE
Mailing Address - Street 2:APT. 413
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1461
Mailing Address - Country:US
Mailing Address - Phone:505-263-9810
Mailing Address - Fax:
Practice Address - Street 1:803 TIJERAS AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3096
Practice Address - Country:US
Practice Address - Phone:505-243-2223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-04982104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker