Healthcare Provider Details

I. General information

NPI: 1891637609
Provider Name (Legal Business Name): JESSICA BERENSON LISW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2741 INDIAN SCHOOL RD NE
ALBUQUERQUE NM
87106-2653
US

IV. Provider business mailing address

6805 TESUQUE DR NW
ALBUQUERQUE NM
87120-4811
US

V. Phone/Fax

Practice location:
  • Phone: 505-926-1780
  • Fax:
Mailing address:
  • Phone: 505-926-1780
  • 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: JESSICA BERENSON
Title or Position: OWNER
Credential: LISW
Phone: 505-926-1780