Mona Lisa Sandoval, AA
Individual provider Active NPI Clinical Social Worker · Raton, NM
NPI 1720211857 · NPPES record last updated Jan 22, 2020
Key facts
- NPI
- 1720211857
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- M-10129 (NM)
- Practice address
- 101 Letton Dr
Raton, NM 87740-4366 - Phone
- (575) 383-2065
- Fax
- (575) 445-0540
- NPI assigned
- Aug 24, 2009
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Associate of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M-10129 | NM | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | M-10129 | NM | Yes |
Addresses
Primary practice location
101 Letton Dr
Raton, NM 87740-4366
Mailing address
101 Letton Dr
Raton, NM 87740-4366
Phone (575) 383-2065
NPI Registry JSON
{
"created_epoch": "1251072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1579651200000",
"number": "1720211857",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 LETTON DR",
"city": "RATON",
"state": "NM",
"postal_code": "877404366",
"telephone_number": "575-383-2065",
"fax_number": "575-445-0540"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 LETTON DR",
"city": "RATON",
"state": "NM",
"postal_code": "877404366",
"telephone_number": "575-383-2065",
"fax_number": "575-445-0540"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDOVAL",
"first_name": "MONA",
"middle_name": "LISA",
"name_prefix": "Ms.",
"credential": "AA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-08-24",
"last_updated": "2020-01-22",
"certification_date": "2020-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NM",
"license": "M-10129",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Raton, NM
- Evelyn Marie Salazar
- Alexis Nicole Sanchez
- April L Sanchez
- Buck Sanchez
- Cassandra Sanchez
- Linde A Schuster
- Edwin Grant Scott Jr.
- Charles Leslie Secora
- Carla Linn Segotta
- David Segura
All providers in Raton, NM · Clinical Social Worker in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.