Healthcare Provider Details

I. General information

NPI: 1558905117
Provider Name (Legal Business Name): CATHERINE V HYDE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1532 TAOS ST
SANTA FE NM
87505-3836
US

IV. Provider business mailing address

PO BOX 45681
RIO RANCHO NM
87174-5681
US

V. Phone/Fax

Practice location:
  • Phone: 505-234-6151
  • Fax:
Mailing address:
  • Phone: 505-226-1960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-12060
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: