Healthcare Provider Details

I. General information

NPI: 1629548847
Provider Name (Legal Business Name): IRMA JESSICA SALGADO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA SALGADO LMSW

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9180 COORS BLVD NW APT 2905
ALBUQUERQUE NM
87120-3122
US

IV. Provider business mailing address

9180 COORS BLVD NW APT 2905
ALBUQUERQUE NM
87120-3122
US

V. Phone/Fax

Practice location:
  • Phone: 505-929-9224
  • Fax:
Mailing address:
  • Phone: 505-929-9224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-11909
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: