Provider Demographics
NPI:1730240391
Name:RICE, KATHRYN AGATA (MSW LISW)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:AGATA
Last Name:RICE
Suffix:
Gender:F
Credentials:MSW LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31535
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87594
Mailing Address - Country:US
Mailing Address - Phone:505-438-2004
Mailing Address - Fax:505-438-4595
Practice Address - Street 1:1660 OLD PECOS TRAIL
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505
Practice Address - Country:US
Practice Address - Phone:505-469-9259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNMI4097104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMA4229Medicaid
NMNM100251OtherVALUE OPTIONS NM