Inner Path Wellness, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C-09020 Issued in NM

Legal business name

INNER PATH WELLNESS, LLC

Practice address

200 Rosemont Ave NE Apt C
Albuquerque, NM 87102-1599

Phone

(505) 750-3605

Fax

(505) 340-3941

NPI assigned

Sep 3, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Jessica Ayesha Rodrigues Sundram, LCSWNPI 1841505138

Title

Owner

Phone

(505) 750-3605

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jessica Ayesha Rodrigues Sundram

  • Clinical Social Worker
  • Albuquerque, NM
  • NPI 1841505138
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1504396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626739200000",
    "number": "1831617448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 MENAUL BLVD NW STE A PMB 468",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871079951",
            "telephone_number": "505-750-3605",
            "fax_number": "505-340-3941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 ROSEMONT AVE NE APT C",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871021599",
            "telephone_number": "505-750-3605",
            "fax_number": "505-340-3941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNER PATH WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-03",
        "last_updated": "2021-07-20",
        "certification_date": "2021-07-20",
        "status": "A",
        "authorized_official_last_name": "SUNDRAM",
        "authorized_official_first_name": "JESSICA AYESHA",
        "authorized_official_middle_name": "RODRIGUES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-750-3605",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NM",
            "license": "C-09020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "59605251",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Clinical Social Worker in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.