Healthcare Provider Details

I. General information

NPI: 1861929903
Provider Name (Legal Business Name): ANTOINETTE KUEHN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2017
Last Update Date: 05/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 WELLESLEY DR SE
ALBUQUERQUE NM
87106-1443
US

IV. Provider business mailing address

123 WELLESLEY DR SE
ALBUQUERQUE NM
87106-1443
US

V. Phone/Fax

Practice location:
  • Phone: 505-795-4334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-08175
License Number StateNM

VIII. Authorized Official

Name: ANTOINETTE KUEHN
Title or Position: OWNER
Credential: LCSW
Phone: 505-795-4334