Provider Demographics
NPI:1639740608
Name:SMITH, JESSICA LAURA (LMSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LAURA
Last Name:SMITH
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 1:2807 CARRETAS CT
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-1912
Mailing Address - Country:US
Mailing Address - Phone:575-551-1757
Mailing Address - Fax:
Practice Address - Street 1:2351 25TH ST UNIT B
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-8722
Practice Address - Country:US
Practice Address - Phone:575-446-5321
Practice Address - Fax:575-446-5309
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-11487104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker