Healthcare Provider Details

I. General information

NPI: 1245245711
Provider Name (Legal Business Name): MICHELE R DICUBELLIS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 PARK AVE SW APT 202
ALBUQUERQUE NM
87102-2869
US

IV. Provider business mailing address

1325 PARK AVE SW APT 202
ALBUQUERQUE NM
87102-2869
US

V. Phone/Fax

Practice location:
  • Phone: 505-720-6884
  • Fax:
Mailing address:
  • Phone: 505-720-6884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-06250
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: