Provider Demographics
NPI:1982946364
Name:POPE, KATHRYN J (LISW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:J
Last Name:POPE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:JANICE
Other - Last Name:POPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1233 STUTZ DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-6232
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2601 WYOMING BLVD NE STE 218
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1033
Practice Address - Country:US
Practice Address - Phone:505-504-6697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-23
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM45983542Medicaid