Provider Demographics
NPI:1417034927
Name:KAIL, JOHN J (LISW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:KAIL
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 CAMINO DEL TORREON
Mailing Address - Street 2:
Mailing Address - City:PLACITAS
Mailing Address - State:NM
Mailing Address - Zip Code:87043-8617
Mailing Address - Country:US
Mailing Address - Phone:505-867-3942
Mailing Address - Fax:505-867-3916
Practice Address - Street 1:6739 ACADEMY RD NE
Practice Address - Street 2:SUITE 234
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3351
Practice Address - Country:US
Practice Address - Phone:505-720-9394
Practice Address - Fax:505-867-3916
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-36971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical