Individual provider Active NPI

Kathryn Rebecca Fortune-Gallagher, LMSW, ACSW

  • Clinical Social Worker
  • Las Cruces, NM
National Provider Identifier
1285914119
Registry record updated Jan 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SWB-2025-0561. Issued in NM
Practice address
2623 Blue Heron PL
Las Cruces, NM 88011-4392
Phone
(734) 260-3777
Fax
(999) 999-9999
NPI assigned
Aug 23, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 8, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 097803-01 NY
Clinical Social Worker 1041C0700X SWB-2025-0561. NM Primary
Social Worker 104100000X 6801067347 MI

Addresses

Primary practice location

2623 Blue Heron PL
Las Cruces, NM 88011-4392

Mailing address

2623 Blue Heron PL
Las Cruces, NM 88011-4392
Phone (734) 260-3777

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, NM, NY3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20190125001835 MI Practitioner - Clinical Social Worker 0840537049 Reassigns benefits to 1 organization
I20251218004531 NM Practitioner - Clinical Social Worker 0840537049 Reassigns benefits to 2 organizations
I20260107004445 NY Practitioner - Clinical Social Worker 0840537049 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1992
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

500 Westover Dr
Sanford, NC 27330-8941

66 E Flagler St
Miami, FL 33130-1807

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SWB-2025-0561.NMMDClinical Social Worker
097803-01NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Grow Healthcare Group PA Clinical CurrentSince Nov 12, 2025 Accepting new patients
Mental Health Specialty Group PA CurrentSince Feb 1, 2026 Accepting new patients
Shine Medical Providers PC Past Accepting new patients
Uplift Behavioral Health PC Clinical Past Accepting new patients

Locations

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

250 Monroe Ave NW
Ste 400
Grand Rapids, MI 49503
Phone (616) 441-4616

500 Marquette Ave NW
Ste 1200
Albuquerque, NM 87102
Phone (505) 295-6685

500 Marquette Ave NW
Albuquerque, NM 87102
Phone (505) 429-5750

165 Broadway
Fl 23
New York, NY 10006
Phone (202) 972-4964

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1314057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767830400000",
    "number": "1285914119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2623 BLUE HERON PL",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880114392",
            "telephone_number": "734-260-3777",
            "fax_number": "999-999-9999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2623 BLUE HERON PL",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880114392",
            "telephone_number": "734-260-3777",
            "fax_number": "999-999-9999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORTUNE-GALLAGHER",
        "first_name": "KATHRYN",
        "middle_name": "REBECCA",
        "credential": "LMSW, ACSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-08-23",
        "last_updated": "2026-01-08",
        "certification_date": "2026-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "097803-01",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NM",
            "license": "SWB-2025-0561.",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801067347",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Cruces, NM

Sources for this page

Verify at the official NPI Registry.