Provider Demographics
NPI:1851571897
Name:JOHNSON, KATHERINE/KATE JOHANNA (LCSW)
Entity type:Individual
Prefix:MS
First Name:KATHERINE/KATE
Middle Name:JOHANNA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:JOHANNA
Other - Last Name:WALDRIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3204 MONTEREY AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2310
Mailing Address - Country:US
Mailing Address - Phone:505-401-9148
Mailing Address - Fax:
Practice Address - Street 1:1325 WYOMING BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-5046
Practice Address - Country:US
Practice Address - Phone:505-291-5300
Practice Address - Fax:505-291-5327
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-081881041C0700X
NMI-081881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM6700586Medicaid