Healthcare Provider Details

I. General information

NPI: 1063577559
Provider Name (Legal Business Name): KAREN L. KLINEFELTER LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 01/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 MARQUEZ PL 203A
SANTA FE NM
87505-1834
US

IV. Provider business mailing address

1012 MARQUEZ PL 203A
SANTA FE NM
87505-1834
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-5027
  • Fax: 505-466-4836
Mailing address:
  • Phone: 505-988-5027
  • Fax: 505-466-4836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-0909
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: