Individual
JENNIFER BANEGAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3100 OAK ST, LAS CRUCES, NM 88005-3425
(575) 323-3354
(575) 523-3354
Mailing address
1001 S DIAMOND AVE, DEMING, NM 88030-4710
(575) 546-0427
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
324887
NM
Other
Enumeration date
01/11/2008
Last updated
04/21/2017
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