Provider Demographics
NPI:1114770245
Name:SAUCEDO-GRAHAM, MARITSA ELENA (LMSW)
Entity Type:Individual
Prefix:
First Name:MARITSA
Middle Name:ELENA
Last Name:SAUCEDO-GRAHAM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3885 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-5796
Mailing Address - Country:US
Mailing Address - Phone:406-215-0100
Mailing Address - Fax:
Practice Address - Street 1:3885 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-5796
Practice Address - Country:US
Practice Address - Phone:406-215-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LMSW-LIC-57316104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker