Healthcare Provider Details

I. General information

NPI: 1164876983
Provider Name (Legal Business Name): CATHERINE BOLLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY OF NM BLDG 73 MSC-06-3870
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

1 UNIVERSITY OF NM BLDG 73 MSC-06-3870
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-277-3136
  • Fax:
Mailing address:
  • Phone: 505-277-3136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-3968
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: