Healthcare Provider Details

I. General information

NPI: 1376086298
Provider Name (Legal Business Name): CYNTHIA SONTAG, LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2016
Last Update Date: 11/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 13TH ST NW
ALBUQUERQUE NM
87102-1834
US

IV. Provider business mailing address

310 13TH ST NW
ALBUQUERQUE NM
87102-1834
US

V. Phone/Fax

Practice location:
  • Phone: 505-263-1001
  • Fax: 505-234-1019
Mailing address:
  • Phone: 505-263-1001
  • Fax: 505-234-1019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-1991
License Number StateNM

VIII. Authorized Official

Name: MS. CYNTHIA SONTAG
Title or Position: SOCIAL WORKER
Credential: LCSW
Phone: 505-263-1001