Healthcare Provider Details

I. General information

NPI: 1013122811
Provider Name (Legal Business Name): SARAH MARIE SKOTERRO LPCC, LADAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10425 4TH ST NW
ALBUQUERQUE NM
87114-2217
US

IV. Provider business mailing address

10425 4TH ST NW
ALBUQUERQUE NM
87114-2217
US

V. Phone/Fax

Practice location:
  • Phone: 206-718-0866
  • Fax:
Mailing address:
  • Phone: 206-718-0866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCCMH0071031
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: