Healthcare Provider Details

I. General information

NPI: 1518038793
Provider Name (Legal Business Name): JIMMY L. WASHINGTON LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 TIJERAS AVE NW
ALBUQUERQUE NM
87102-3096
US

IV. Provider business mailing address

6001 MOON ST NE APT. 413
ALBUQUERQUE NM
87111-1461
US

V. Phone/Fax

Practice location:
  • Phone: 505-243-2223
  • Fax:
Mailing address:
  • Phone: 505-263-9810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM-04982
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: