Provider Demographics
NPI:1821592403
Name:DRAKE-FEINBERG, JENNIFER A
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:DRAKE-FEINBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 CANADA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:SANDIA PARK
Mailing Address - State:NM
Mailing Address - Zip Code:87047-9658
Mailing Address - Country:US
Mailing Address - Phone:575-779-2126
Mailing Address - Fax:
Practice Address - Street 1:4300 SAN MATEO BLVD NE STE B186
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-8409
Practice Address - Country:US
Practice Address - Phone:505-226-2839
Practice Address - Fax:505-295-2559
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB20240715101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM18127835Medicaid