Provider Demographics
NPI:1437894847
Name:SANDOVAL, DORA J (LMSW)
Entity Type:Individual
Prefix:
First Name:DORA
Middle Name:J
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:DORA
Other - Middle Name:J
Other - Last Name:SANDOVAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:725 STAGECOACH RD SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-4126
Mailing Address - Country:US
Mailing Address - Phone:505-489-2094
Mailing Address - Fax:
Practice Address - Street 1:725 STAGECOACH RD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-4126
Practice Address - Country:US
Practice Address - Phone:505-489-2094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-10257101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health