Healthcare Provider Details

I. General information

NPI: 1083635981
Provider Name (Legal Business Name): SIGIFREDO SAENZ JR. MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 BROADWAY BLVD SE
ALBUQUERQUE NM
87102-3425
US

IV. Provider business mailing address

7012 COMANCHE RD NE
ALBUQUERQUE NM
87110-1402
US

V. Phone/Fax

Practice location:
  • Phone: 505-463-0388
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-0168
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: