Kathleen Henderson, LBSW
Individual provider Active NPI School Social Worker · Bloomfield, NM
NPI 1174007157 · NPPES record last updated Sep 17, 2018
Key facts
- NPI
- 1174007157
- Entity type
- Individual (NPI type 1)
- Primary specialty
- School Social Worker 1041S0200X
- License
- B-08513 (NM)
- Practice address
- 310 La Jara St
Bloomfield, NM 87413-6626 - Phone
- (505) 634-3863
- NPI assigned
- Sep 17, 2018
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| B-08513 | NM | MD | School Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Social Worker |
1041S0200X | B-08513 | NM | Yes |
Addresses
Primary practice location
310 La Jara St
Bloomfield, NM 87413-6626
Mailing address
310 La Jara St
Bloomfield, NM 87413-6626
Phone (505) 634-3863
Other providers in Bloomfield, NM
- William R Hall
- Lisa Hamilton
- Bryan Wayne Harber
- Cheryl Hare
- Douglas K Harris
- Christina L Herbig
- Connie Hernandez
- Roy Hernandez
- Ariel Rose Howard
- Colleen Hudson
All providers in Bloomfield, NM · School Social Worker in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.