Provider Demographics
NPI:1790203479
Name:VIGIL, ANNA (LCSW)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:VIGIL
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CADENA ST
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:NM
Mailing Address - Zip Code:88048-9348
Mailing Address - Country:US
Mailing Address - Phone:575-636-7117
Mailing Address - Fax:
Practice Address - Street 1:525 S MELENDRES ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2805
Practice Address - Country:US
Practice Address - Phone:575-636-7117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM10080104100000X
NMC120171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM03775046Medicaid