Provider Demographics
NPI:1053094185
Name:JEPSEN, DARCIE (LMSW)
Entity type:Individual
Prefix:
First Name:DARCIE
Middle Name:
Last Name:JEPSEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:577 STATE ROAD 344
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015
Mailing Address - Country:US
Mailing Address - Phone:505-832-5700
Mailing Address - Fax:
Practice Address - Street 1:SOUTH MOUNTAIN ELEMENTARY SCHOOL
Practice Address - Street 2:577 STATE ROAD 344
Practice Address - City:EDGEWOOD
Practice Address - State:NM
Practice Address - Zip Code:87015
Practice Address - Country:US
Practice Address - Phone:505-832-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2022-1015104100000X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker