Provider Demographics
NPI:1336357680
Name:SACCONE, DENISE (LISW)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:
Last Name:SACCONE
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 1:825 CALLE MEJIA
Mailing Address - Street 2:APT 431
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1417
Mailing Address - Country:US
Mailing Address - Phone:505-989-1233
Mailing Address - Fax:505-989-1233
Practice Address - Street 1:1435 SOUTH ST FRANCIS DRIVE
Practice Address - Street 2:ROOM 205
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505
Practice Address - Country:US
Practice Address - Phone:505-501-4410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI049941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM17277OtherMESA MENTAL HEALTH
NM00NM00JP23OtherBLUE CROSS BLUE SHIELD
NM70207836Medicaid