Provider Demographics
NPI:1578618666
Name:SAPIENZA, ELISA (LMFT)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:SAPIENZA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 JUAN TABO BLVD NE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3984
Mailing Address - Country:US
Mailing Address - Phone:505-400-2960
Mailing Address - Fax:505-298-3939
Practice Address - Street 1:3900 JUAN TABO BLVD NE
Practice Address - Street 2:SUITE 8
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3984
Practice Address - Country:US
Practice Address - Phone:505-400-2960
Practice Address - Fax:505-298-3939
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0086421106H00000X
CAMFC 38437106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM39776263Medicaid
567584OtherVALUE OPTIONS
NM00JN73OtherBLUE CROSS BLUE SHIELD