Provider Demographics
NPI:1225222318
Name:HOCKEY, KATHLEEN (LISW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:HOCKEY
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 93746
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87199-3746
Mailing Address - Country:US
Mailing Address - Phone:505-353-2466
Mailing Address - Fax:
Practice Address - Street 1:2921 CARLISLE BLVD NE
Practice Address - Street 2:SUITE 124
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-2865
Practice Address - Country:US
Practice Address - Phone:505-353-2466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-05842101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1730112483Medicaid