Healthcare Provider Details

I. General information

NPI: 1023343118
Provider Name (Legal Business Name): KATHERYN ROSE BARRY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4619 GREENE ST NW STE C
ALBUQUERQUE NM
87114-4899
US

IV. Provider business mailing address

905 PRINCETON DR SE
ALBUQUERQUE NM
87106-3034
US

V. Phone/Fax

Practice location:
  • Phone: 505-899-9329
  • Fax:
Mailing address:
  • Phone: 505-991-9669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2023-0590
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2006008051
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: