Provider Demographics
NPI:1003658311
Name:GILBERT, JASON FOLEY (LSAA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:FOLEY
Last Name:GILBERT
Suffix:
Gender:M
Credentials:LSAA
Other - Prefix:
Other - First Name:JASON
Other - Middle Name:FOLEY
Other - Last Name:CAPRIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21 RANCH RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR CREST
Mailing Address - State:NM
Mailing Address - Zip Code:87008-9712
Mailing Address - Country:US
Mailing Address - Phone:505-681-0499
Mailing Address - Fax:
Practice Address - Street 1:630 HAINES AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1226
Practice Address - Country:US
Practice Address - Phone:505-268-5611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2024-0411101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)