Healthcare Provider Details

I. General information

NPI: 1396145280
Provider Name (Legal Business Name): SANDRA L MORALES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 ENTERPRISE RD
SOCORRO NM
87801-4199
US

IV. Provider business mailing address

1300 ENTERPRISE RD
SOCORRO NM
87801-4199
US

V. Phone/Fax

Practice location:
  • Phone: 575-835-4444
  • Fax:
Mailing address:
  • Phone: 575-835-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-11713
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: