Individual
MS. JEANNETTE MADELENE BACA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW
Contact information
Practice address
1918 HOPEWELL ST, UNIT A, SANTA FE, NM 87505-3856
(505) 992-8900
(505) 992-8905
Mailing address
PO BOX 6338, SANTA FE, NM 87502-6338
(505) 992-8900
(505) 992-8905
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I-06515
NM
Other
Enumeration date
10/04/2007
Last updated
10/04/2007
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