Provider Demographics
NPI:1700544020
Name:JEFFERSON MONTESSORI ACADEMY
Entity Type:Organization
Organization Name:JEFFERSON MONTESSORI ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-234-1701
Mailing Address - Street 1:500 W. CHURCH STREET
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220
Mailing Address - Country:US
Mailing Address - Phone:575-234-1703
Mailing Address - Fax:575-887-9391
Practice Address - Street 1:500 W. CHURCH STREET
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220
Practice Address - Country:US
Practice Address - Phone:575-234-1703
Practice Address - Fax:575-887-9391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty