Provider Demographics
NPI:1477739878
Name:APOLONIA, ESTRELLA C (LISW)
Entity Type:Individual
Prefix:
First Name:ESTRELLA
Middle Name:C
Last Name:APOLONIA
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:STELLA
Other - Middle Name:A
Other - Last Name:DELGADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:MORA
Mailing Address - State:NM
Mailing Address - Zip Code:87732-0209
Mailing Address - Country:US
Mailing Address - Phone:575-387-2201
Mailing Address - Fax:575-387-9006
Practice Address - Street 1:13 MORA VALLEY CLINIC RD.
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:NM
Practice Address - Zip Code:87732-0209
Practice Address - Country:US
Practice Address - Phone:575-387-2201
Practice Address - Fax:575-387-9006
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-071171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM048504Medicaid