Provider Demographics
NPI:1184313777
Name:JRIDI, SHARDAI LENAE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:SHARDAI
Middle Name:LENAE
Last Name:JRIDI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SHARDAI
Other - Middle Name:LENAE
Other - Last Name:PIOCHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 W BROADWAY # D&E
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-5638
Mailing Address - Country:US
Mailing Address - Phone:505-327-4796
Mailing Address - Fax:
Practice Address - Street 1:1001 W BROADWAY # D&E
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5638
Practice Address - Country:US
Practice Address - Phone:505-327-4796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2023-0337104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker