Provider Demographics
NPI:1801924493
Name:KANE, WHITNEY (LISW)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:KANE
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:UNM CHILDRENS PSYCHIATRIC CTR
Mailing Address - Street 2:2600 MARBLE NE BLDG.#2
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-2190
Mailing Address - Fax:505-272-3466
Practice Address - Street 1:UNM CHILDRENS PSYCHIATRIC CTR
Practice Address - Street 2:2600 MARBLE NE BLDG.#2
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-2190
Practice Address - Fax:505-272-3466
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM 5775104100000X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM95020063Medicaid