Provider Demographics
NPI:1811576341
Name:VIGIL, MANDY (LCSW)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:VIGIL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 ANTEQUERA RD NW APT 408
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-4575
Mailing Address - Country:US
Mailing Address - Phone:505-620-0411
Mailing Address - Fax:
Practice Address - Street 1:8805 W 14TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-4848
Practice Address - Country:US
Practice Address - Phone:720-943-7080
Practice Address - Fax:720-316-7577
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical