Provider Demographics
NPI:1902815525
Name:HOCKEMEIER, KIRSTEN M (LISW)
Entity Type:Individual
Prefix:MS
First Name:KIRSTEN
Middle Name:M
Last Name:HOCKEMEIER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MRS
Other - First Name:KIRSTEN
Other - Middle Name:M
Other - Last Name:CHOUBARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:1600 SAN PEDRO DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-6734
Mailing Address - Country:US
Mailing Address - Phone:505-404-0717
Mailing Address - Fax:505-999-1172
Practice Address - Street 1:2601 WYOMING BLVD NE
Practice Address - Street 2:SUITE 101
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112
Practice Address - Country:US
Practice Address - Phone:505-404-0717
Practice Address - Fax:505-999-1172
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLISW - I-33871041C0700X
NMI-33871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
11700402OtherCAQH
NM071433Medicaid
NMZ1433Medicaid