Healthcare Provider Details

I. General information

NPI: 1821592403
Provider Name (Legal Business Name): JENNIFER A DRAKE-FEINBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 SAN MATEO BLVD NE STE B186
ALBUQUERQUE NM
87110-8409
US

IV. Provider business mailing address

23 CANADA VISTA DR
SANDIA PARK NM
87047-9658
US

V. Phone/Fax

Practice location:
  • Phone: 505-226-2839
  • Fax: 505-295-2559
Mailing address:
  • Phone: 575-779-2126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB20240715
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: