Provider Demographics
NPI:1871740712
Name:KAISER, JOAN E (MA)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:E
Last Name:KAISER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 CORTEZ PL
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-2440
Mailing Address - Country:US
Mailing Address - Phone:505-989-3379
Mailing Address - Fax:
Practice Address - Street 1:404 CORTEZ PL
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-2440
Practice Address - Country:US
Practice Address - Phone:505-989-3379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLPCC 3372101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health