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NPI Code Detail

MEDICARE: MARITSA ELENA SAUCEDO-GRAHAM LMSW

MEDICARE: MARITSA ELENA SAUCEDO-GRAHAM LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerBBH-LMSW-LIC-57316MT

General Provider Information

NPI Number : 1114770245
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARITSA ELENA SAUCEDO-GRAHAM LMSW
Provider Business Mailing Address
First Line : 3885 W BROADWAY ST
Second Line :
City : MISSOULA
State : MT
Zip : 59808-5796
Country : US
Telephone Number : 406-215-0100
Fax Number :
Provider Business Practice Location Address
First Line : 3885 W BROADWAY ST
Second Line :
City : MISSOULA
State : MT
Zip : 59808-5796
Country : US
Telephone Number : 406-215-0100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2024
Last Update Date : 04/09/2024

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Directions to “ MARITSA ELENA SAUCEDO-GRAHAM LMSW” Practice Location

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