Healthcare Provider Details

I. General information

NPI: 1275602781
Provider Name (Legal Business Name): KAREN M DOYLE LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1482 S SAINT FRANCIS DR STE B
SANTA FE NM
87505-4098
US

IV. Provider business mailing address

PO BOX 10233
SANTA FE NM
87504-6233
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-2470
  • Fax: 505-982-2606
Mailing address:
  • Phone: 505-982-2470
  • Fax: 505-982-2606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI0884
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: