Provider Demographics
NPI:1215037858
Name:CARLEY, SANDRA J (EDD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:J
Last Name:CARLEY
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4767 CORRALES RD
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-8618
Mailing Address - Country:US
Mailing Address - Phone:505-898-2809
Mailing Address - Fax:505-897-0883
Practice Address - Street 1:4767 CORRALES RD
Practice Address - Street 2:
Practice Address - City:CORRALES
Practice Address - State:NM
Practice Address - Zip Code:87048-8618
Practice Address - Country:US
Practice Address - Phone:505-898-2809
Practice Address - Fax:505-897-0883
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM432103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical