Provider Demographics
NPI:1568707511
Name:MCROBERTS, KASIA (LPCC)
Entity Type:Individual
Prefix:
First Name:KASIA
Middle Name:
Last Name:MCROBERTS
Suffix:
Gender:F
Credentials:LPCC
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 23804
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87502-3804
Mailing Address - Country:US
Mailing Address - Phone:505-316-4283
Mailing Address - Fax:
Practice Address - Street 1:505 CAMINO DE LOS MARQUEZ
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-1837
Practice Address - Country:US
Practice Address - Phone:505-316-4283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0166541101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM373208784Medicaid