Healthcare Provider Details

I. General information

NPI: 1629524160
Provider Name (Legal Business Name): SHEILA JIMENEZ MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2016
Last Update Date: 08/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 SILVER AVE SE
ALBUQUERQUE NM
87108
US

IV. Provider business mailing address

1615 PROPPS ST NE
ALBUQUERQUE NM
87112
US

V. Phone/Fax

Practice location:
  • Phone: 505-463-6486
  • Fax:
Mailing address:
  • Phone: 505-463-6486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberX-09774
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: