Healthcare Provider Details

I. General information

NPI: 1730835026
Provider Name (Legal Business Name): SARAH HENRY MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 CARLISLE BLVD NE STE 105
ALBUQUERQUE NM
87110-1680
US

IV. Provider business mailing address

11340 ACADEMY RIDGE RD NE
ALBUQUERQUE NM
87111-6895
US

V. Phone/Fax

Practice location:
  • Phone: 505-410-1379
  • Fax:
Mailing address:
  • Phone: 505-440-7773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2023-0474
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: