Provider Demographics
NPI:1730783291
Name:ELVERUM, KATHARINE MAY (CCSW)
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:MAY
Last Name:ELVERUM
Suffix:
Gender:F
Credentials:CCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 FIR ST
Mailing Address - Street 2:
Mailing Address - City:T OR C
Mailing Address - State:NM
Mailing Address - Zip Code:87901-1724
Mailing Address - Country:US
Mailing Address - Phone:575-740-9648
Mailing Address - Fax:575-894-3106
Practice Address - Street 1:808 FIR ST
Practice Address - Street 2:
Practice Address - City:T OR C
Practice Address - State:NM
Practice Address - Zip Code:87901-1724
Practice Address - Country:US
Practice Address - Phone:575-740-9648
Practice Address - Fax:575-894-3106
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator