Provider Demographics
NPI:1235723693
Name:SARDINAS, LIEN
Entity Type:Individual
Prefix:
First Name:LIEN
Middle Name:
Last Name:SARDINAS
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 1:2201 SAN PEDRO DR. NE
Mailing Address - Street 2:BLDG 1, SUITE 220
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-2268
Mailing Address - Country:US
Mailing Address - Phone:505-830-3153
Mailing Address - Fax:
Practice Address - Street 1:2201 SAN PEDRO DR. NE
Practice Address - Street 2:BLDG 1, SUITE 220
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-2268
Practice Address - Country:US
Practice Address - Phone:505-830-3153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-114861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical