Provider Demographics
NPI:1841393402
Name:PEUGH, SARA (MSW LISW)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:PEUGH
Suffix:
Gender:F
Credentials:MSW LISW
Other - Prefix:MRS
Other - First Name:SARA
Other - Middle Name:G
Other - Last Name:ELLER-PEUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW LISW
Mailing Address - Street 1:PO BOX 44970
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87174
Mailing Address - Country:US
Mailing Address - Phone:505-899-2911
Mailing Address - Fax:505-898-1173
Practice Address - Street 1:3615 SR 528
Practice Address - Street 2:STE 201
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114
Practice Address - Country:US
Practice Address - Phone:505-899-2911
Practice Address - Fax:505-898-1173
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI01441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00R599OtherBLUE CROSS BS