Healthcare Provider Details

I. General information

NPI: 1780719658
Provider Name (Legal Business Name): CRYSTAL HEREDIA-SANCHEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 LIVINGSTON LOOP STE C1
SANTA TERESA NM
88008-9753
US

IV. Provider business mailing address

100 W GRIGGS AVE
LAS CRUCES NM
88001-1234
US

V. Phone/Fax

Practice location:
  • Phone: 575-824-9000
  • Fax: 866-232-9241
Mailing address:
  • Phone: 575-647-2800
  • Fax: 575-647-2898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-06430
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: