MEDICARE: MS. JENNIFER J. SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	NM600724	NM

General Provider Information

NPI Number	:	1487987962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER J. SMITH

Provider Business Mailing Address
First Line	:	6721 ACADEMY RD NE
Second Line	:	SUITE A
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-3393
Country	:	US
Telephone Number	:	505-944-6927
Fax Number	:	505-342-4416

Provider Business Practice Location Address
First Line	:	3900 OSUNA RD NE
Second Line	:	SUITE 245 AND 222
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-4459
Country	:	US
Telephone Number	:	505-344-2877
Fax Number	:	505-342-4416

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2009
Last Update Date	:	09/15/2009

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