Individual provider Active NPI

Jennifer Leigh Bonalumi, LMSW, LADAC

  • Clinical Social Worker
  • Las Cruces, NM
National Provider Identifier
1942519152
Registry record updated Feb 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
X-08726 Issued in NM
Practice address
100 W Griggs Ave
Las Cruces, NM 88001-1234
Phone
(575) 647-2800
Fax
(575) 647-2898
NPI assigned
Oct 5, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X M-06691 NM
Addiction (Substance Use Disorder) Counselor 101YA0400X 0138441 NM
Clinical Social Worker 1041C0700X X-08726 NM Primary

Addresses

Primary practice location

100 W Griggs Ave
Las Cruces, NM 88001-1234

Mailing address

100 W Griggs Ave
Las Cruces, NM 88001-1234
Phone (575) 647-2800

Other identifiers 1

IdentifierTypeStateIssuer
18677037MedicaidNM

Other names 1

  • Jennifer Thibeault Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150616000567 NM Practitioner - Clinical Social Worker 0446561617 Practice locations: Las Cruces, NM

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1980 E Lohman Ave
Suite B
Las Cruces, NM 88001-3194
Phone (575) 496-7298

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0138441NMMDAddiction (Substance Use Disorder) Counselor
M-06691NMMDSocial Worker
X-08726NMMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1286236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423526400000",
    "number": "1942519152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 W GRIGGS AVE",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880011234",
            "telephone_number": "575-647-2800",
            "fax_number": "575-647-2898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 W GRIGGS AVE",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880011234",
            "telephone_number": "575-647-2800",
            "fax_number": "575-647-2898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONALUMI",
        "first_name": "JENNIFER",
        "middle_name": "LEIGH",
        "name_prefix": "Ms.",
        "credential": "LMSW, LADAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-05",
        "last_updated": "2015-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NM",
            "license": "M-06691",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NM",
            "license": "0138441",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NM",
            "license": "X-08726",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "18677037",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "THIBEAULT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Las Cruces, NM

Sources for this page

Verify at the official NPI Registry.