Healthcare Provider Details

I. General information

NPI: 1417554536
Provider Name (Legal Business Name): JEMIA WARNER LSW,LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 EUBANK BLVD NE STE 1
ALBUQUERQUE NM
87112-5300
US

IV. Provider business mailing address

735A SILVERBERRY CIR SE
ALBUQUERQUE NM
87116-3108
US

V. Phone/Fax

Practice location:
  • Phone: 505-361-1957
  • Fax:
Mailing address:
  • Phone: 312-342-1939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: