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General NPI Number Information
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NPI Number | 1275294308
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Entity Type | Individual
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Provider Name | JAZMINE DENEE BOOTH LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/30/2021
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 4300 SAN MATEO BLVD NE STE B186
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-8409
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Country | US
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Telephone | 505-226-2839
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Fax | 505-295-2559
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Provider Business Mailing Address
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Address Line | 4300 SAN MATEO BLVD NE STE B186
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-8409
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Country | US
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Telephone | 505-226-2839
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Fax | 505-295-2559
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | M-11460
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SWB-2024-0505
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License Number State | NM
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