Provider Demographics
NPI:1255409678
Name:PAJAK, SHELLEY JEAN (LMSW)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:JEAN
Last Name:PAJAK
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 1:2011 TROY KING RD # SP.433
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-3158
Mailing Address - Country:US
Mailing Address - Phone:505-325-0935
Mailing Address - Fax:
Practice Address - Street 1:501 AIRPORT DR STE 253
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-2646
Practice Address - Country:US
Practice Address - Phone:505-325-2778
Practice Address - Fax:505-325-6171
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM04980104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker