Basic Information
| Provider Information | |||||||||
| NPI: | 1487125761 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLIFFORD | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 425 WESTERN SKIES DR SE APT 614 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871233768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053879003 | ||||||||
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| Practice Location | |||||||||
| Address1: | 630 HAINES AVE NW | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871021226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052685611 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2018 | ||||||||
| LastUpdateDate: | 12/11/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | X-10552 | NM | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.