Provider Demographics
NPI:1538125141
Name:JENNINGS, LYDIA ZEPEDA (MS)
Entity Type:Individual
Prefix:MS
First Name:LYDIA
Middle Name:ZEPEDA
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 ST FRANCIS DR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501
Mailing Address - Country:US
Mailing Address - Phone:505-989-3798
Mailing Address - Fax:505-989-3798
Practice Address - Street 1:1502 ST FRANCIS DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501
Practice Address - Country:US
Practice Address - Phone:505-989-3798
Practice Address - Fax:505-389-3798
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0620101YM0800X
CA102804103TS0200X
NM1551106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist