Provider Demographics
NPI:1295379923
Name:HERD, SONIA M
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:M
Last Name:HERD
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 1:312 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPITAN
Mailing Address - State:NM
Mailing Address - Zip Code:88316
Mailing Address - Country:US
Mailing Address - Phone:575-808-9430
Mailing Address - Fax:
Practice Address - Street 1:312 5TH ST
Practice Address - Street 2:
Practice Address - City:CAPITAN
Practice Address - State:NM
Practice Address - Zip Code:88316
Practice Address - Country:US
Practice Address - Phone:575-808-9430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-06
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NMSWB-2023-08571041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician