Healthcare Provider Details

I. General information

NPI: 1609939685
Provider Name (Legal Business Name): CATHY W KARLIN LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5520 WYOMING NE
ALBURQUERQUE NM
87109-3238
US

IV. Provider business mailing address

6900 RUSTLER RD
ALBURQUERQUE NM
87120
US

V. Phone/Fax

Practice location:
  • Phone: 505-291-1818
  • Fax: 505-291-0332
Mailing address:
  • Phone: 505-291-1818
  • Fax: 505-291-0332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberX05487
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: