Provider Demographics
NPI:1467713651
Name:BRATCHER, MARY ANGELICA
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANGELICA
Last Name:BRATCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 N CANAL ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-5110
Mailing Address - Country:US
Mailing Address - Phone:575-885-4836
Mailing Address - Fax:575-887-9579
Practice Address - Street 1:1700 W MAIN ST
Practice Address - Street 2:STE A2
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-3711
Practice Address - Country:US
Practice Address - Phone:575-746-8890
Practice Address - Fax:575-746-2383
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-074531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical