Healthcare Provider Details

I. General information

NPI: 1215058896
Provider Name (Legal Business Name): KAREN DIANE WEBER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 N DATE ST
TRUTH OR CONSEQUENCES NM
87901-2824
US

IV. Provider business mailing address

PO BOX 7
CABALLO NM
87931-0007
US

V. Phone/Fax

Practice location:
  • Phone: 505-894-8383
  • Fax: 505-894-0606
Mailing address:
  • Phone: 505-743-3575
  • Fax: 505-743-3579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number300963
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: