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: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARQUETTE AVE NW
ALBUQUERQUE NM
87102-5340
US

IV. Provider business mailing address

110 STARGAZE LN
ST AUGUSTINE FL
32095-7632
US

V. Phone/Fax

Practice location:
  • Phone: 465-650-5557
  • Fax:
Mailing address:
  • Phone: 505-401-2030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-09033
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: