MEDICARE: KINSHIP THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326920398
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINSHIP THERAPY LLC

Provider Business Mailing Address
First Line	:	741 TERRACE DR
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4918
Country	:	US
Telephone Number	:	505-617-0202
Fax Number	:

Provider Business Practice Location Address
First Line	:	741 TERRACE DR
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4918
Country	:	US
Telephone Number	:	505-617-0202
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	VANESSA D LUCERO
Credential	:	LCSW
Telephone Number	:	505-617-0202

Provider Enumeration Date	:	07/22/2025
Last Update Date	:	07/22/2025

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Directions to “KINSHIP THERAPY LLC ” Practice Location

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