Provider Demographics
NPI:1174548002
Name:MARRUFO, SADIE D (MA, LPCC)
Entity type:Individual
Prefix:
First Name:SADIE
Middle Name:D
Last Name:MARRUFO
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 TOHATCHI TRL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87104-1918
Mailing Address - Country:US
Mailing Address - Phone:505-306-3008
Mailing Address - Fax:505-242-4240
Practice Address - Street 1:2715 4TH ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1329
Practice Address - Country:US
Practice Address - Phone:505-836-1303
Practice Address - Fax:505-836-3810
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM7935838Medicaid