Provider Demographics
NPI:1881865962
Name:KERSHNER, ELIZABETH ANNE (LMSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
Last Name:KERSHNER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 MONTGOMERY BLVD NE
Mailing Address - Street 2:#136
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-0900
Mailing Address - Country:US
Mailing Address - Phone:505-269-9631
Mailing Address - Fax:505-837-9631
Practice Address - Street 1:3825 MONTGOMERY BLVD NE
Practice Address - Street 2:#136
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-0900
Practice Address - Country:US
Practice Address - Phone:505-269-9631
Practice Address - Fax:505-837-9631
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-06727104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker