Provider Demographics
NPI:1588397871
Name:CONVERY, KATHERINE IRENE (LSAA, LMSW-P)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:IRENE
Last Name:CONVERY
Suffix:
Gender:F
Credentials:LSAA, LMSW-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 DEMOSS ST.
Mailing Address - Street 2:
Mailing Address - City:LORDSBURG
Mailing Address - State:NM
Mailing Address - Zip Code:88045
Mailing Address - Country:US
Mailing Address - Phone:575-800-1467
Mailing Address - Fax:
Practice Address - Street 1:3200 N. BYPASS RD.
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061
Practice Address - Country:US
Practice Address - Phone:575-800-1467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2022-0252101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)