Provider Demographics
NPI:1245249291
Name:OWENS, CATHLEEN M (LISW)
Entity type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:M
Last Name:OWENS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1349
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88062-1349
Mailing Address - Country:US
Mailing Address - Phone:505-388-4497
Mailing Address - Fax:505-534-1150
Practice Address - Street 1:315 S HUDSON
Practice Address - Street 2:SUITE 19
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061
Practice Address - Country:US
Practice Address - Phone:505-388-4497
Practice Address - Fax:505-534-1150
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-22561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM98941Medicaid
NM98941Medicaid