| Sandia Sol Therapy Llc | |
|
4004 Carlisle Blvd Ne Ste T Albuquerque NM 87107-4539 | |
| (505) 226-3042 | |
| (505) 441-2845 |
| Full Name | Sandia Sol Therapy Llc |
|---|---|
| Speciality | Social Worker |
| Location | 4004 Carlisle Blvd Ne Ste T, Albuquerque, New Mexico |
| Authorized Official Name and Position | Tanya Baker (OWNER) |
| Authorized Official Contact | 5056049578 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sandia Sol Therapy Llc Po Box 91987 Albuquerque NM 87199-1987 Ph: (505) 226-3042 | Sandia Sol Therapy Llc 4004 Carlisle Blvd Ne Ste T Albuquerque NM 87107-4539 Ph: (505) 226-3042 |
| NPI Number | 1184363277 |
|---|---|
| Provider Enumeration Date | 05/27/2022 |
| Last Update Date | 08/12/2022 |
| Certification Date | 08/12/2022 |
| Medicare PECOS PAC ID | 6406388487 |
|---|---|
| Medicare Enrollment ID | O20241015003734 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184363277 | NPI | - | NPPES |
| 36854719 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Rebecca Jane Zamora |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770038648 PECOS PAC ID: 3375823420 Enrollment ID: I20161206002067 |
| Provider Name | Tanya B Baker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437635927 PECOS PAC ID: 4082022066 Enrollment ID: I20210412000598 |
| Provider Name | Larissa Willsey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609599141 PECOS PAC ID: 0941678254 Enrollment ID: I20221117001587 |
| Provider Name | Andrea Ohara |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1912347816 PECOS PAC ID: 1850823626 Enrollment ID: I20241017002806 |
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