Provider Demographics
NPI:1972823789
Name:BUBENHOFER, SONDRA ANN (MSW)
Entity Type:Individual
Prefix:MS
First Name:SONDRA
Middle Name:ANN
Last Name:BUBENHOFER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 JANE PL NE
Mailing Address - Street 2:APT. 120
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-5139
Mailing Address - Country:US
Mailing Address - Phone:505-717-1004
Mailing Address - Fax:
Practice Address - Street 1:3011 JANE PL NE
Practice Address - Street 2:APT 120
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-5139
Practice Address - Country:US
Practice Address - Phone:505-717-1004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-07175101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health