Provider Demographics
NPI:1700230570
Name:SANDERVILLE, LINDA (MSW, LICSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:SANDERVILLE
Suffix:
Gender:F
Credentials:MSW, LICSW, LCSW
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:PEPERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4600 PARADISE BLVD NW UNIT 66884
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87193-4978
Mailing Address - Country:US
Mailing Address - Phone:505-317-7444
Mailing Address - Fax:505-461-1456
Practice Address - Street 1:4600 PARADISE BLVD NW UNIT 66884
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87193-4978
Practice Address - Country:US
Practice Address - Phone:505-317-7444
Practice Address - Fax:505-461-1456
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPSW8101041C0700X
VA09040113291041C0700X
DCLC500796291041C0700X
MD153581041C0700X
NMC-102501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical