Provider Demographics
NPI:1295067387
Name:DUBY, JESSICA L (LMSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:DUBY
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 1:49TH MEDICAL GROUP/SGHW
Mailing Address - Street 2:280 FIRST STREET
Mailing Address - City:HOLLOMAN AFB
Mailing Address - State:NM
Mailing Address - Zip Code:88330-8273
Mailing Address - Country:US
Mailing Address - Phone:575-572-5880
Mailing Address - Fax:575-572-3003
Practice Address - Street 1:49TH MEDICAL GROUP/SGHW
Practice Address - Street 2:280 FIRST STREET
Practice Address - City:HOLLOMAN AFB
Practice Address - State:NM
Practice Address - Zip Code:88330-8273
Practice Address - Country:US
Practice Address - Phone:575-572-5880
Practice Address - Fax:575-572-3003
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-07534104100000X
NMX-06871104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker