Provider Demographics
NPI:1396145280
Name:MORALES, SANDRA L (LCSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:MORALES
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 1:1 FOSTER LANE
Mailing Address - Street 2:
Mailing Address - City:RESERVE
Mailing Address - State:NM
Mailing Address - Zip Code:87830
Mailing Address - Country:US
Mailing Address - Phone:575-533-6456
Mailing Address - Fax:575-533-6767
Practice Address - Street 1:1 FOSTER LANE
Practice Address - Street 2:
Practice Address - City:RESERVE
Practice Address - State:NM
Practice Address - Zip Code:87830
Practice Address - Country:US
Practice Address - Phone:575-533-6456
Practice Address - Fax:575-533-6767
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-117131041C0700X
NMX-09215104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM18677037Medicaid