Healthcare Provider Details

I. General information

NPI: 1629509096
Provider Name (Legal Business Name): CATHERINE YANKUSKIE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 S ALAMEDA BLVD
LAS CRUCES NM
88005-2818
US

IV. Provider business mailing address

2701 E YANDELL DR
EL PASO TX
79903-3726
US

V. Phone/Fax

Practice location:
  • Phone: 575-449-4000
  • Fax: 575-449-4021
Mailing address:
  • Phone: 915-562-1999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM-10084
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberX-09983
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-11123
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: