Healthcare Provider Details

I. General information

NPI: 1255611976
Provider Name (Legal Business Name): KATHRYN FEHR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2011
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 MOUNTAIN RD NW
ALBUQUERQUE NM
87104-1359
US

IV. Provider business mailing address

440 BURBANK AVE APT 4312
PONTE VEDRA FL
32081-1132
US

V. Phone/Fax

Practice location:
  • Phone: 505-557-4656
  • Fax: 505-514-0874
Mailing address:
  • Phone: 505-401-2030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-09033
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: