MEDICARE: JESSICA CAUTHORNE LMSW

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	1041C0700X	Clinical Social Worker	M-06671	NM

General Provider Information

NPI Number	:	1619344322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA CAUTHORNE LMSW

Provider Business Mailing Address
First Line	:	2971 LONG BOW LOOP
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-5218
Country	:	US
Telephone Number	:	575-993-8713
Fax Number	:

Provider Business Practice Location Address
First Line	:	2971 LONG BOW LOOP
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-5218
Country	:	US
Telephone Number	:	575-993-8713
Fax Number	:

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

Provider Enumeration Date	:	08/28/2015
Last Update Date	:	08/28/2015

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