Provider Demographics
NPI:1093842353
Name:MIRABAL, ANGELA P (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:P
Last Name:MIRABAL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 OAK ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3425
Mailing Address - Country:US
Mailing Address - Phone:575-323-3354
Mailing Address - Fax:575-523-2299
Practice Address - Street 1:3100 OAK ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3425
Practice Address - Country:US
Practice Address - Phone:575-323-3354
Practice Address - Fax:575-523-2299
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-094381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMT9188Medicaid