Provider Demographics
NPI:1518554773
Name:VICENTE, MARIANGELES (MSW)
Entity Type:Individual
Prefix:
First Name:MARIANGELES
Middle Name:
Last Name:VICENTE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:MARIANGELES
Other - Middle Name:R
Other - Last Name:VICENTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:121 TRACY CIR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-3236
Mailing Address - Country:US
Mailing Address - Phone:413-320-7460
Mailing Address - Fax:
Practice Address - Street 1:121 TRACY CIR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-3236
Practice Address - Country:US
Practice Address - Phone:413-320-7460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10249971041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool