Provider Demographics
NPI:1821443755
Name:ROLLASON, KATHLEEN MANSHIP (MSW, LISW, LCSW,ACSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MANSHIP
Last Name:ROLLASON
Suffix:
Gender:F
Credentials:MSW, LISW, LCSW,ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ENEBRO CT
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-8836
Mailing Address - Country:US
Mailing Address - Phone:505-699-5668
Mailing Address - Fax:
Practice Address - Street 1:1 ENEBRO CT
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-8836
Practice Address - Country:US
Practice Address - Phone:505-699-5668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-057441041C0700X
AR6976-C1041C0700X
LA41001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical