Individual
JEFFREY VERSAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.I.S.W.
Contact information
Practice address
669 TERRACE AVE., B, CHAMA, NM 87520
(575) 209-1250
Mailing address
PO BOX 1502, DULCE, NM 87528-1502
(575) 209-1250
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
I-05349
NM
Other
Enumeration date
01/06/2009
Last updated
01/06/2009
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