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Individual

MRS. JAMIE MARIE MCDONALD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
8300 CONSTITUTION AVE NE, PMG AT 8300 CONSTITUTION POB, ALBUQUERQUE, NM 87110-7613
(505) 559-6100
(505) 559-6101
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
I3041
NM
1041C0700X
Clinical Social Worker
Primary
C-3041
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
46635858
NM
Enumeration date
03/19/2007
Last updated
06/24/2015
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