Provider Demographics
NPI:1003510918
Name:TERRAZAS, SANDRA M
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:M
Last Name:TERRAZAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:NM
Mailing Address - Zip Code:88021-8846
Mailing Address - Country:US
Mailing Address - Phone:575-882-6101
Mailing Address - Fax:
Practice Address - Street 1:1325 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:NM
Practice Address - Zip Code:88021-8846
Practice Address - Country:US
Practice Address - Phone:575-882-6101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2022-1100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker