Healthcare Provider Details

I. General information

NPI: 1639740608
Provider Name (Legal Business Name): JESSICA LAURA SMITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 25TH ST UNIT B
ALAMOGORDO NM
88310-8722
US

IV. Provider business mailing address

260 BOSQUE
ALAMOGORDO NM
88310-9554
US

V. Phone/Fax

Practice location:
  • Phone: 575-446-5321
  • Fax: 575-446-5309
Mailing address:
  • Phone: 575-551-1757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2024-0334
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: