Provider Demographics
NPI:1538173893
Name:SAGERT, KRISTIN (MSW, LISW)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:SAGERT
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 TIERRA ENCANTADA
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-6811
Mailing Address - Country:US
Mailing Address - Phone:505-890-7686
Mailing Address - Fax:505-890-9432
Practice Address - Street 1:185 TIERRA ENCANTADA
Practice Address - Street 2:
Practice Address - City:CORRALES
Practice Address - State:NM
Practice Address - Zip Code:87048-6811
Practice Address - Country:US
Practice Address - Phone:505-890-7686
Practice Address - Fax:505-890-9432
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-37731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM01JA75OtherBLUE CROSS BLUE SHIELD
NM201021327OtherPRESBYTERIAN
NMNM102268Medicaid
NM349981000OtherMAGELLAN
NMNM102268Medicaid