Healthcare Provider Details

I. General information

NPI: 1538173893
Provider Name (Legal Business Name): KRISTIN SAGERT MSW, LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 10/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 TIERRA ENCANTADA
CORRALES NM
87048-6811
US

IV. Provider business mailing address

185 TIERRA ENCANTADA
CORRALES NM
87048-6811
US

V. Phone/Fax

Practice location:
  • Phone: 505-890-7686
  • Fax: 505-890-9432
Mailing address:
  • Phone: 505-890-7686
  • Fax: 505-890-9432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-3773
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: