Provider Demographics
NPI:1962848119
Name:GASKILL, SABRINA (LCSW)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:GASKILL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:TUCUMCARI
Mailing Address - State:NM
Mailing Address - Zip Code:88401
Mailing Address - Country:US
Mailing Address - Phone:575-461-7909
Mailing Address - Fax:
Practice Address - Street 1:1005 S MONROE ST
Practice Address - Street 2:
Practice Address - City:TUCUMCARI
Practice Address - State:NM
Practice Address - Zip Code:88401-3208
Practice Address - Country:US
Practice Address - Phone:575-461-3013
Practice Address - Fax:575-461-1169
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-08167101YM0800X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health