Healthcare Provider Details

I. General information

NPI: 1851571897
Provider Name (Legal Business Name): KATHERINE/KATE JOHANNA JOHNSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATE JOHANNA WALDRIP LCSW

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 WYOMING BLVD NE
ALBUQUERQUE NM
87112-5046
US

IV. Provider business mailing address

3204 MONTEREY AVE SE
ALBUQUERQUE NM
87106-2310
US

V. Phone/Fax

Practice location:
  • Phone: 505-291-5300
  • Fax: 505-291-5327
Mailing address:
  • Phone: 505-401-9148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-08188
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-08188
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: