Basic Information
Provider Information
NPI: 1619645611
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SANCHEZ
FirstName: MARIA
MiddleName: ANNA
NamePrefix:  
NameSuffix:  
Credential: LMSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1800 COMMUNITY
Address2:  
City: CLINTON
State: MO
PostalCode: 647358804
CountryCode: US
TelephoneNumber: 6608858131
FaxNumber:  
Practice Location
Address1: 501 N SUNSET LN
Address2:  
City: RAYMORE
State: MO
PostalCode: 640839402
CountryCode: US
TelephoneNumber: 8448538937
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/03/2021
LastUpdateDate: 09/03/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/03/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
104100000X11518KSN Behavioral Health & Social Service ProvidersSocial Worker 
104100000X2020024618MOY Behavioral Health & Social Service ProvidersSocial Worker 

No ID Information.


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