Provider Demographics
NPI:1306888292
Name:MANN, SABRINA ILUTZI (LISW)
Entity type:Individual
Prefix:MRS
First Name:SABRINA
Middle Name:ILUTZI
Last Name:MANN
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 1:929 MADISON ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-6214
Mailing Address - Country:US
Mailing Address - Phone:505-232-2929
Mailing Address - Fax:505-765-1100
Practice Address - Street 1:4233 MONTGOMERY BLVD NE
Practice Address - Street 2:SUITE 240 WEST
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-6749
Practice Address - Country:US
Practice Address - Phone:505-766-5311
Practice Address - Fax:505-883-3076
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-05014104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM00JL92OtherBCBS
NM202004937OtherPRESBYTERIAN
NM88731511Medicaid