Provider Demographics
NPI:1902966567
Name:MIQUEL, MATHILDE ELISE (LCSW)
Entity Type:Individual
Prefix:
First Name:MATHILDE
Middle Name:ELISE
Last Name:MIQUEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MATTY
Other - Middle Name:
Other - Last Name:MIQUEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4628 LA VIDA NUEVA DEL SUR SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-2659
Mailing Address - Country:US
Mailing Address - Phone:505-918-6824
Mailing Address - Fax:
Practice Address - Street 1:4628 LA VIDA NUEVA DEL SUR SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-2659
Practice Address - Country:US
Practice Address - Phone:505-918-6824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-050851041C0700X
247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical