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NPI Code Detail

MEDICARE: MS. SANDRA CECELIA BODGE CASE MANAGER

MEDICARE: MS. SANDRA CECELIA BODGE CASE MANAGER
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
1101YM0800XMental Health CounselorT-0096331NM

General Provider Information

NPI Number : 1235181371
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SANDRA CECELIA BODGE CASE MANAGER
Provider Business Mailing Address
First Line : POB 2916
Second Line :
City : RANCHOS DE TAOS
State : NM
Zip : 87557
Country : US
Telephone Number : 505-770-2404
Fax Number :
Provider Business Practice Location Address
First Line : 67 SUGAR LN
Second Line :
City : EL PRADO
State : NM
Zip : 87529
Country : US
Telephone Number : 575-770-2404
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2006
Last Update Date : 01/22/2024

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