Healthcare Provider Details

I. General information

NPI: 1023222635
Provider Name (Legal Business Name): BARBARA JEANNE SMITH LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BJ SMITH LISW

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 12/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19478 HIGHWAY 314
BELEN NM
87002-8223
US

IV. Provider business mailing address

PO BOX 323
JARALES NM
87023-0323
US

V. Phone/Fax

Practice location:
  • Phone: 505-859-0814
  • Fax:
Mailing address:
  • Phone: 505-859-0814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-2548
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: