Individual
MAISIE JACQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3510 MESSINA DR, FARMINGTON, NM 87402-4782
(505) 609-8299
Mailing address
3510 MESSINA DR, FARMINGTON, NM 87402-4782
(505) 210-1029
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
06/16/2020
Last updated
07/27/2026
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