Healthcare Provider Details

I. General information

NPI: 1376433318
Provider Name (Legal Business Name): KERRI MAY ANDERSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1823 CAMINO DE SALUD
ALBUQUERQUE NM
87106-3782
US

IV. Provider business mailing address

504 AMHERST DR NE
ALBUQUERQUE NM
87106-1310
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4866
  • Fax:
Mailing address:
  • Phone: 804-921-6896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2025-0338
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: