MEDICARE: KATHRYN FEHR LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	1041C0700X	Clinical Social Worker	C-09033	NM

General Provider Information

NPI Number	:	1255611976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN FEHR LCSW

Provider Business Mailing Address
First Line	:	110 STARGAZE LN
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32095-7632
Country	:	US
Telephone Number	:	505-401-2030
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 MARQUETTE AVE NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87102-5340
Country	:	US
Telephone Number	:	465-650-5557
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2011
Last Update Date	:	09/19/2023

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