Healthcare Provider Details

I. General information

NPI: 1225537186
Provider Name (Legal Business Name): SARA MICHELLE YATSATTIE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2018
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 MONTE LARGO DR NE
ALBUQUERQUE NM
87123-1824
US

IV. Provider business mailing address

1100 MONTE LARGO DR NE
ALBUQUERQUE NM
87123-1824
US

V. Phone/Fax

Practice location:
  • Phone: 505-205-3145
  • Fax:
Mailing address:
  • Phone: 505-205-3145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-0994-2022
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2024-1104
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: