Provider Demographics
NPI:1386821239
Name:SANCHEZ, SUSAN K (MSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 CUT TREE LANE
Mailing Address - Street 2:
Mailing Address - City:BELEN
Mailing Address - State:NM
Mailing Address - Zip Code:87002
Mailing Address - Country:US
Mailing Address - Phone:505-238-2997
Mailing Address - Fax:505-544-4631
Practice Address - Street 1:54 CUT TREE LANE
Practice Address - Street 2:
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002
Practice Address - Country:US
Practice Address - Phone:505-238-2997
Practice Address - Fax:505-544-4631
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-09381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM30435030Medicaid
NMI-0938OtherLICENSE NUMBER
NM3803775Medicaid