Provider Demographics
NPI:1285914093
Name:KUEHN, ANTOINETTE (LCSW)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:KUEHN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 SIERRA BLANCA
Mailing Address - Street 2:
Mailing Address - City:CEDAR CREST
Mailing Address - State:NM
Mailing Address - Zip Code:87008-9445
Mailing Address - Country:US
Mailing Address - Phone:505-795-4334
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY OF NEW MEXICO BUILDING 73 MSC06 3870
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131
Practice Address - Country:US
Practice Address - Phone:505-277-3136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-069661041S0200X
NMC-081751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMM-06966Medicaid
NMM-06966OtherLMSW
NME7606OtherLMSW
NME7606Medicaid