Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | M-08648 | NM |
NPI | 1003209230 |
---|---|
Provider Name | Sarah Sartin |
First Address | Hatch, NM 87937-0370 |
Second Address | Deming, NM 88030-8629 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2015 |
Last Update Date | 27/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
71376887 | (05) | NM |