Individual
JACKIE ANNE MORENO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
415 W HEMLOCK ST, DEMING, NM 88030-3622
(575) 545-2459
Mailing address
2605 S GOLD AVE, DEMING, NM 88030-6507
(575) 545-8171
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
M-09535
NM
Other
Enumeration date
09/06/2017
Last updated
09/06/2017
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