Provider Demographics
NPI:1265406722
Name:MARGO, ANNETTE IDA (PHD)
Entity type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:IDA
Last Name:MARGO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 N CONWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-2349
Mailing Address - Country:US
Mailing Address - Phone:956-519-9000
Mailing Address - Fax:956-519-7722
Practice Address - Street 1:2504 N CONWAY AVE
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78574-2349
Practice Address - Country:US
Practice Address - Phone:956-519-9000
Practice Address - Fax:956-519-7722
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23862103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00G63YMedicare ID - Type UnspecifiedMEDICARE