Kathleen M Phillips
Individual provider Active NPI Social Worker · Moriarty, NM
NPI 1659591097 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1659591097
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- I-05054 (NM)
- Practice address
- 200 Center Street
Moriarty, NM 87035-0000 - Phone
- (505) 832-5817
- Fax
- (505) 832-5918
- NPI assigned
- Apr 26, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
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 |
|---|---|---|---|
| I-05054 | NM | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Moriarty Municipal School | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | I-05054 | NM | Yes |
Addresses
Primary practice location
200 Center Street
Moriarty, NM 87035-0000
Mailing address
PO Box 2000
Moriarty, NM 87035-2000
Phone (505) 832-5817
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 35402334 | Medicaid | NM |
Other providers in Moriarty, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. 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.