Provider Demographics
NPI:1194919811
Name:JASSER, SHAREEN AMINA
Entity type:Individual
Prefix:
First Name:SHAREEN
Middle Name:AMINA
Last Name:JASSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHIREEN
Other - Middle Name:AMINA
Other - Last Name:JASSER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8620 EAGLE SPRINGS DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1260
Mailing Address - Country:US
Mailing Address - Phone:505-690-4602
Mailing Address - Fax:
Practice Address - Street 1:8620 EAGLE SPRINGS DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1260
Practice Address - Country:US
Practice Address - Phone:505-690-4602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-06690104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker