Provider Demographics
NPI:1194854687
Name:MACFARLAND, JESSIE BROWN (SW)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:BROWN
Last Name:MACFARLAND
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12200 LOMAS BLVD NE
Mailing Address - Street 2:MANZANO HIGH SCHOOL
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-5804
Mailing Address - Country:US
Mailing Address - Phone:505-559-2220
Mailing Address - Fax:
Practice Address - Street 1:12200 LOMAS BLVD NE
Practice Address - Street 2:MANZANO HIGH SCHOOL
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-5804
Practice Address - Country:US
Practice Address - Phone:505-559-2220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI 4450104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMA 4744Medicaid