Provider Demographics
NPI:1023343118
Name:BARRY, KATHERYN ROSE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KATHERYN
Middle Name:ROSE
Last Name:BARRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 PRINCETON DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-3034
Mailing Address - Country:US
Mailing Address - Phone:505-991-9669
Mailing Address - Fax:
Practice Address - Street 1:4619 GREENE ST NW STE C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-4899
Practice Address - Country:US
Practice Address - Phone:505-899-9329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2023-05901041C0700X
MO20060080511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical