Provider Demographics
NPI:1265292551
Name:PUTMAN-ENGLE, KAREN K
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:K
Last Name:PUTMAN-ENGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 MILLICENT ROGERS RD
Mailing Address - Street 2:
Mailing Address - City:EL PRADO
Mailing Address - State:NM
Mailing Address - Zip Code:87529-7564
Mailing Address - Country:US
Mailing Address - Phone:575-779-3778
Mailing Address - Fax:
Practice Address - Street 1:1040 MILLICENT ROGERS RD
Practice Address - Street 2:
Practice Address - City:EL PRADO
Practice Address - State:NM
Practice Address - Zip Code:87529-7564
Practice Address - Country:US
Practice Address - Phone:575-779-3778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
M-114431041S0200X
NMM-114431041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool