Individual
ANITA A VIGIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW
Contact information
Practice address
1206 N RIVERSIDE DR, ESPANOLA, NM 87532-2811
(505) 747-0102
(505) 753-9758
Mailing address
PO BOX 231, ESPANOLA, NM 87532-0231
(505) 747-6809
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I-1343
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
67437
—
NM
Enumeration date
04/24/2007
Last updated
07/08/2007
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