Provider Demographics
NPI:1275860942
Name:SANCHEZ, MELBA REGINA (LMSW)
Entity Type:Individual
Prefix:
First Name:MELBA
Middle Name:REGINA
Last Name:SANCHEZ
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 1:1756 AVENIDA LOS GRIEGOS NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-3449
Mailing Address - Country:US
Mailing Address - Phone:505-514-5844
Mailing Address - Fax:
Practice Address - Street 1:1422 PASEO DE PERALTA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-4391
Practice Address - Country:US
Practice Address - Phone:505-514-5844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-079631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM78558Medicaid