Healthcare Provider Details

I. General information

NPI: 1689078586
Provider Name (Legal Business Name): CALLIE KNAPP LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2014
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 CIRQUELA RD
CEDAR CREST NM
87008-9716
US

IV. Provider business mailing address

400 GOLD AVE SW STE 1300W
ALBUQUERQUE NM
87102-3283
US

V. Phone/Fax

Practice location:
  • Phone: 505-281-4481
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2023-0372
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: