Healthcare Provider Details

I. General information

NPI: 1174548002
Provider Name (Legal Business Name): SADIE D. MARRUFO MA., LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 4TH ST NW
ALBUQUERQUE NM
87107-1329
US

IV. Provider business mailing address

216 TOHATCHI TRL NW
ALBUQUERQUE NM
87104-1918
US

V. Phone/Fax

Practice location:
  • Phone: 505-836-1303
  • Fax: 505-836-3810
Mailing address:
  • Phone: 505-306-3008
  • Fax: 505-242-4240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: