Provider Demographics
NPI:1275294308
Name:BOOTH, JAZMINE DENEE (LCSW)
Entity type:Individual
Prefix:
First Name:JAZMINE
Middle Name:DENEE
Last Name:BOOTH
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 SAN MATEO BLVD NE STE B186
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-8409
Mailing Address - Country:US
Mailing Address - Phone:505-226-2839
Mailing Address - Fax:505-295-2559
Practice Address - Street 1:4300 SAN MATEO BLVD NE STE B186
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-8409
Practice Address - Country:US
Practice Address - Phone:505-226-2839
Practice Address - Fax:505-295-2559
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-30
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-11460104100000X
NMSWB-2024-05051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker