Healthcare Provider Details

I. General information

NPI: 1053094185
Provider Name (Legal Business Name): DARCIE JEPSEN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SOUTH MOUNTAIN ELEMENTARY SCHOOL 577 STATE ROAD 344
EDGEWOOD NM
87015
US

IV. Provider business mailing address

577 STATE ROAD 344
EDGEWOOD NM
87015
US

V. Phone/Fax

Practice location:
  • Phone: 505-832-5700
  • Fax:
Mailing address:
  • Phone: 505-832-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2022-1015
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberSWB-2022-1015
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: