Provider Demographics
NPI:1861925380
Name:SABAQUIE, JOSEPH (LSAA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:SABAQUIE
Suffix:
Gender:M
Credentials:LSAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 TESUQUE ST
Mailing Address - Street 2:
Mailing Address - City:KEWA
Mailing Address - State:NM
Mailing Address - Zip Code:87052-9998
Mailing Address - Country:US
Mailing Address - Phone:505-465-2733
Mailing Address - Fax:505-465-0433
Practice Address - Street 1:10 TESUQUE ST
Practice Address - Street 2:
Practice Address - City:KEWA
Practice Address - State:NM
Practice Address - Zip Code:87052-9998
Practice Address - Country:US
Practice Address - Phone:505-465-2733
Practice Address - Fax:505-465-0433
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0171041101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)