Provider Demographics
NPI:1871504274
Name:SLATTERY, MARY KATHLEEN (MSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHLEEN
Last Name:SLATTERY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:SLATTERY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW
Mailing Address - Street 1:3949 CORRALES RD
Mailing Address - Street 2:STE 180
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-9349
Mailing Address - Country:US
Mailing Address - Phone:505-440-2581
Mailing Address - Fax:
Practice Address - Street 1:3949 CORRALES RD
Practice Address - Street 2:STE 180
Practice Address - City:CORRALES
Practice Address - State:NM
Practice Address - Zip Code:87048-9349
Practice Address - Country:US
Practice Address - Phone:505-440-2581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI046781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical