Healthcare Provider Details

I. General information

NPI: 1407090947
Provider Name (Legal Business Name): SANDRA CRANE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W GRIGGS AVE
LAS CRUCES NM
88001-1234
US

IV. Provider business mailing address

100 W GRIGGS AVE
LAS CRUCES NM
88001-1234
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-7260
  • Fax: 575-522-1355
Mailing address:
  • Phone: 575-522-7260
  • Fax: 575-522-1355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberC4327
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: