| Doctor Name: | SANDRA M FORTIER |
| NPI Number: | 1023199338 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LISW |
| License Number: | I-06875 |
| Business Practice Address: | 4351 Jager Dr Ne Suite C Rio Rancho, NM - 871447523 |
| Business Phone Number: | 5054105686 |
| Business Fax Number: | |
| Mailing Address: | 4 Camino Mesteno, PLACITAS |
| State: | NM |
| Postal Code: | 870438623 |
| Phone Number: | 5057719279 |
| Fax Number: | |
| NPI Enumeration Date: | 10/17/2006 |
| NPI Last Update Date: | 12/14/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | I-06875 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |