Provider Demographics
NPI:1326380445
Name:DARAKJY, JENNIFER ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN
Last Name:DARAKJY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5300 MCNUTT ROAD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-9438
Mailing Address - Country:US
Mailing Address - Phone:575-332-9138
Mailing Address - Fax:915-231-6111
Practice Address - Street 1:5300 MCNUTT RD
Practice Address - Street 2:SUITE 12
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9606
Practice Address - Country:US
Practice Address - Phone:915-588-0223
Practice Address - Fax:915-231-6111
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36433103T00000X
NM1267103T00000X
NM0049C103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103T00000XBehavioral Health & Social Service ProvidersPsychologist