Provider Demographics
NPI:1366073314
Name:ELLIOTT, KATHARINE BRONSON (LCSW)
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:BRONSON
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BRONSON
Other - Middle Name:
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1056 QUINCY ST SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-3512
Mailing Address - Country:US
Mailing Address - Phone:505-331-6574
Mailing Address - Fax:
Practice Address - Street 1:231 SIERRA DR SE STE 7
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-5633
Practice Address - Country:US
Practice Address - Phone:505-331-6574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2024-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker