Provider Demographics
NPI:1669928552
Name:SANDOVAL, MERCEDES (LMSW)
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:MERCEDES
Other - Middle Name:M
Other - Last Name:SANDOVAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:9945 BELLEVUE ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4112
Mailing Address - Country:US
Mailing Address - Phone:505-338-2320
Mailing Address - Fax:
Practice Address - Street 1:500 LASER RD NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-4517
Practice Address - Country:US
Practice Address - Phone:505-896-0667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2684261041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool