Provider Demographics
NPI:1891059879
Name:STEVENS, SARA ANNE (LISW)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:ANNE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-4238
Mailing Address - Country:US
Mailing Address - Phone:505-454-3900
Mailing Address - Fax:505-454-3961
Practice Address - Street 1:727 7TH ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4238
Practice Address - Country:US
Practice Address - Phone:505-454-3900
Practice Address - Fax:505-454-3961
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-07354104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker