Provider Demographics
NPI:1760704373
Name:NORTHROP, SANDRA LEE (LGSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:NORTHROP
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LEE
Other - Last Name:NORTHROP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:1218 GRIEGOS RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-3752
Mailing Address - Country:US
Mailing Address - Phone:505-345-8471
Mailing Address - Fax:505-342-5414
Practice Address - Street 1:1218 GRIEGOS RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-3752
Practice Address - Country:US
Practice Address - Phone:505-345-8471
Practice Address - Fax:505-342-5414
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-06907104100000X
AL2435G104100000X
WI127903-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker