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Individual

MS. JESSICA AYESHA RODRIGUES SUNDRAM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
200 ROSEMONT AVE NE APT C, ALBUQUERQUE, NM 87102-1599
(505) 750-3605
(505) 340-3941
Mailing address
300 MENAUL BLVD NW STE A PMB 468, ALBUQUERQUE, NM 87107-9951
(505) 750-3605
(505) 340-3941

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C-09020
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
40657043
NM
Enumeration date
08/11/2010
Last updated
07/20/2021
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