Individual
JESSICA VICTORIA BACA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2001 CENTRO FAMILIAR BLVD SW, ALBUQUERQUE, NM 87105-4592
(505) 873-7400
Mailing address
8512 MESA SPRINGS AVE SW, ALBUQUERQUE, NM 87121-7036
(505) 304-8197
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SWB-2024-0691
NM
106S00000X
Behavior Technician
—
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Other
Enumeration date
06/06/2023
Last updated
08/16/2024
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