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NPI Code Detail

MEDICARE: KATHRYN M BROCK LCSW

MEDICARE: KATHRYN M BROCK 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
1261QM0850XAdult Mental Health Clinic/CenterC-11496NM
21041C0700XClinical Social WorkerC-11496NM

General Provider Information

NPI Number : 1851058952
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHRYN M BROCK LCSW
Provider Business Mailing Address
First Line : 4116 SKYLINE LOOP NE
Second Line :
City : RIO RANCHO
State : NM
Zip : 87144-1609
Country : US
Telephone Number : 817-729-9099
Fax Number :
Provider Business Practice Location Address
First Line : 4116 SKYLINE LOOP NE
Second Line :
City : RIO RANCHO
State : NM
Zip : 87144-1609
Country : US
Telephone Number : 817-729-9099
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/23/2021
Last Update Date : 12/23/2024

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Directions to “ KATHRYN M BROCK LCSW” Practice Location

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