Provider Demographics
NPI:1194800292
Name:BARRETT, KRISTA ELENA (LISW)
Entity type:Individual
Prefix:MISS
First Name:KRISTA
Middle Name:ELENA
Last Name:BARRETT
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 51834
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87181-1834
Mailing Address - Country:US
Mailing Address - Phone:505-888-1121
Mailing Address - Fax:505-797-0310
Practice Address - Street 1:2418 MILES RD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-3224
Practice Address - Country:US
Practice Address - Phone:505-888-1121
Practice Address - Fax:505-797-0310
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-33131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR4817Medicaid
NMNM00JA67OtherNM BLUE CROSS BLUE SHIELD
NMNM100173OtherVALUE OPTIONS OF NM
NM10007314OtherLOVELACE HEALTH PLAN
NM168841OtherMANAGED HEALTH NETWORK
NM33142552100Medicare ID - Type UnspecifiedMEDICARE