Healthcare Provider Details

I. General information

NPI: 1265779672
Provider Name (Legal Business Name): SHARON APODACA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8009 CANONCITO DR NW
ALBUQUERQUE NM
87120-7057
US

IV. Provider business mailing address

8009 CANONCITO DR NW
ALBUQUERQUE NM
87120-7057
US

V. Phone/Fax

Practice location:
  • Phone: 505-569-3245
  • Fax:
Mailing address:
  • Phone: 505-569-3245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberX-08079
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberM09058
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: