Provider Demographics
NPI:1730313073
Name:BECKER, KATHRYN MARIE (LISW)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:MARIE
Last Name:BECKER
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 1:1822 LOUISE CIR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-2012
Mailing Address - Country:US
Mailing Address - Phone:575-639-0338
Mailing Address - Fax:
Practice Address - Street 1:1401 S DON ROSER DR STE D
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4567
Practice Address - Country:US
Practice Address - Phone:575-522-5144
Practice Address - Fax:575-522-5177
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical