Individual
MS. MARIA INEZ BAGWELL
Active
Individual
MS. MARIA INEZ BAGWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, LADAC
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
0115311
NM
104100000X
Social Worker
M-08562
NM
1041C0700X
Clinical Social Worker
Primary
C-10108
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
52379205
—
NM
01
—
620292YRND
MEDICARE
NM
Enumeration date
06/17/2013
Last updated
08/24/2018
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