Provider Demographics
NPI:1881868313
Name:VOGEL, MARLIESE (LISW)
Entity Type:Individual
Prefix:
First Name:MARLIESE
Middle Name:
Last Name:VOGEL
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:MARLIESE
Other - Middle Name:
Other - Last Name:VOGEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1349
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88062-1349
Mailing Address - Country:US
Mailing Address - Phone:575-388-4497
Mailing Address - Fax:575-534-1150
Practice Address - Street 1:315 S HUDSON ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-6184
Practice Address - Country:US
Practice Address - Phone:575-388-4412
Practice Address - Fax:575-534-1150
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-078671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical