Provider Demographics
NPI:1598217945
Name:EDELSON, KATHERINE R (LMSW, MED)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:R
Last Name:EDELSON
Suffix:
Gender:F
Credentials:LMSW, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 THAXTON AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-4359
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2010 E BIJOU ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5819
Practice Address - Country:US
Practice Address - Phone:719-473-5557
Practice Address - Fax:719-473-6442
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-097761041C0700X
COCSW.099263111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty