Provider Demographics
NPI:1063577559
Name:KLINEFELTER, KAREN L (LISW)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:KLINEFELTER
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 1:1012 MARQUEZ PL
Mailing Address - Street 2:203A
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-1834
Mailing Address - Country:US
Mailing Address - Phone:505-988-5027
Mailing Address - Fax:505-466-4836
Practice Address - Street 1:1012 MARQUEZ PL
Practice Address - Street 2:203A
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-1834
Practice Address - Country:US
Practice Address - Phone:505-988-5027
Practice Address - Fax:505-466-4836
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-09091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00NM0032KOtherBCBS PROVIDER #
NM333434101Medicare ID - Type Unspecified