Healthcare Provider Details

I. General information

NPI: 1124000500
Provider Name (Legal Business Name): SANDRA MARIE HOLLINGSWORTH MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 YALE BLVD NE
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

PO BOX 14502
ALBUQUERQUE NM
87191-4502
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2890
  • Fax: 505-272-0052
Mailing address:
  • Phone: 505-272-2890
  • Fax: 505-272-0052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI05381
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS16337
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: