Individual
PENELOPE KATHLEEN PRATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3501 E MAIN ST, FARMINGTON, NM 87402-5153
(505) 258-4457
Mailing address
3501 E MAIN ST, FARMINGTON, NM 87402-5153
(506) 258-4457
(413) 445-6242
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2023-0884
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
126548
MA SW LICENSE
MA
01
—
15987084
CAQH
—
01
—
2023-0884
NM SW LICENSE
NM
Enumeration date
10/31/2013
Last updated
10/12/2023
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