Provider Demographics
NPI:1477089902
Name:LEDESMA, KATHRYN M (LMSW)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:M
Last Name:LEDESMA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5615 MIRA MONTES
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-8966
Mailing Address - Country:US
Mailing Address - Phone:575-649-9538
Mailing Address - Fax:
Practice Address - Street 1:5615 MIRA MONTES
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88007-8966
Practice Address - Country:US
Practice Address - Phone:575-649-9538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-28401041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool