Healthcare Provider Details

I. General information

NPI: 1568352615
Provider Name (Legal Business Name): CAROLINE KLOCKSIEM LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 S SOLANO DR
LAS CRUCES NM
88001-3758
US

IV. Provider business mailing address

1800 FAIRWAY CIR
LAS CRUCES NM
88011-4910
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-4004
  • Fax:
Mailing address:
  • Phone: 413-387-7328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2026-0805
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: