Healthcare Provider Details

I. General information

NPI: 1275205205
Provider Name (Legal Business Name): JAHNA MARIE PERRINE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 DAVID L GOLDFEIN ST BLDG 23
HOLLOMAN AFB NM
88330-8273
US

IV. Provider business mailing address

2820 CARMEL DR
ALAMOGORDO NM
88310-3824
US

V. Phone/Fax

Practice location:
  • Phone: 575-572-7061
  • Fax: 575-572-1523
Mailing address:
  • Phone: 575-491-4996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2023-0127
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: