MEDICARE: SANDRA MARIE WHITE 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
1	104100000X	Social Worker	M-09388	NM

General Provider Information

NPI Number	:	1285092270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA MARIE WHITE LMSW

Provider Business Mailing Address
First Line	:	2541 PRADO DEL SOL AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4330
Country	:	US
Telephone Number	:	915-525-6483
Fax Number	:

Provider Business Practice Location Address
First Line	:	2541 PRADO DEL SOL AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4330
Country	:	US
Telephone Number	:	915-525-6483
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2016
Last Update Date	:	02/04/2016

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