Individual
MS. JACQUELINE VIVANCO PEREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1330 SAN PEDRO DR NE STE 108, ALBUQUERQUE, NM 87110-6744
(505) 209-9227
Mailing address
PO BOX 72922, ALBUQUERQUE, NM 87195-2922
(505) 209-9227
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
M-05571
NM
1041C0700X
Clinical Social Worker
Primary
C07176
NM
1041C0700X
Clinical Social Worker
I-07176
NM
Other
Enumeration date
09/06/2007
Last updated
02/04/2025
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