Healthcare Provider Details

I. General information

NPI: 1235528829
Provider Name (Legal Business Name): DANIELLE MACAWILE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8338 COMANCHE RD NE STE B
ALBUQUERQUE NM
87110-2357
US

IV. Provider business mailing address

PO BOX 53483
ALBUQUERQUE NM
87153-3483
US

V. Phone/Fax

Practice location:
  • Phone: 505-620-0469
  • Fax: 888-620-8144
Mailing address:
  • Phone: 505-620-0469
  • Fax: 888-620-8144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-08910
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: