Provider Demographics
NPI:1235723693
Name:SARDINAS, LIEN
Entity type:Individual
Prefix:
First Name:LIEN
Middle Name:
Last Name:SARDINAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3009
Mailing Address - Street 2:
Mailing Address - City:RANCHOS DE TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87557-3009
Mailing Address - Country:US
Mailing Address - Phone:610-888-2893
Mailing Address - Fax:
Practice Address - Street 1:1303 PASEO DEL CANON E
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6738
Practice Address - Country:US
Practice Address - Phone:575-751-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-114861041C0700X
NMSWB-2024-00741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical