Provider Demographics
NPI:1659627529
Name:SEGURA, ANGELICA R (MSW)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:R
Last Name:SEGURA
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:P.O. BOX 349
Mailing Address - Street 2:
Mailing Address - City:FORT SUMNER
Mailing Address - State:NM
Mailing Address - Zip Code:88119
Mailing Address - Country:US
Mailing Address - Phone:575-355-2414
Mailing Address - Fax:575-355-7894
Practice Address - Street 1:DE BACA FAMILY PRACTICE CLINIC
Practice Address - Street 2:546 N. 10TH STREET
Practice Address - City:FORT SUMNER
Practice Address - State:NM
Practice Address - Zip Code:88119
Practice Address - Country:US
Practice Address - Phone:575-355-2414
Practice Address - Fax:575-355-7894
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor