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General NPI Number Information
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NPI Number | 1689320731
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Entity Type | Individual
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Provider Name | KIMMBERLY VISCAINO LBSW, LPN
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Gender | Female
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Dates
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Enumeration Date | 02/28/2022
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | 700 E. 3RD ST
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City | PORTALES
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State | NM
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Zip | 88130-6025
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Country | US
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Telephone | 575-356-7045
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Fax | 575-359-0826
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Provider Business Mailing Address
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Address Line | 700 E. 3RD ST
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City | PORTALES
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State | NM
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Zip | 88130
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Country | US
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Telephone | 575-356-7045
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Fax | 575-359-0826
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | B-11042
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License Number State | NM
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