Basic Information
| Provider Information | |||||||||
| NPI: | 1275769911 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CABLE | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | RUTH | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 914 N CANAL ST | ||||||||
| Address2: | |||||||||
| City: | CARLSBAD | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882205110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5758854836 | ||||||||
| FaxNumber: | 5758879579 | ||||||||
| Practice Location | |||||||||
| Address1: | BLDG 1150 BARKLEY RD. | ||||||||
| Address2: | |||||||||
| City: | FT. CARSON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195260175 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2009 | ||||||||
| LastUpdateDate: | 10/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | M-07071 | NM | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | C-07821 | NM | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.