Provider Demographics
NPI:1245245711
Name:DICUBELLIS, MICHELE R (MSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:R
Last Name:DICUBELLIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 PARK AVE SW APT 202
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2869
Mailing Address - Country:US
Mailing Address - Phone:505-720-6884
Mailing Address - Fax:
Practice Address - Street 1:1325 PARK AVE SW APT 202
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2869
Practice Address - Country:US
Practice Address - Phone:505-720-6884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-062501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM38373777Medicaid
NM38373777Medicaid