Provider Demographics
NPI:1265770994
Name:KROLL, CATHERINE ANN (LISW)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANN
Last Name:KROLL
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 1:4700 COAL AVE SE
Mailing Address - Street 2:HIGHLAND HS
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-2804
Mailing Address - Country:US
Mailing Address - Phone:505-265-3711
Mailing Address - Fax:
Practice Address - Street 1:4700 COAL AVE SE
Practice Address - Street 2:HIGHLAND HS
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2804
Practice Address - Country:US
Practice Address - Phone:505-265-3711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI 29161041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNONE ASSIGNEDMedicaid