Healthcare Provider Details

I. General information

NPI: 1609409028
Provider Name (Legal Business Name): MARGOT M FELDVEBEL LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 LUNA CIR NW
ALBUQUERQUE NM
87102-1973
US

IV. Provider business mailing address

1125 FOREST RD NW
ALAMEDA NM
87114-1915
US

V. Phone/Fax

Practice location:
  • Phone: 505-328-9448
  • Fax: 505-340-3764
Mailing address:
  • Phone: 505-328-9448
  • Fax: 505-340-3764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MARGOT MANDIRA FELDVEBEL
Title or Position: CLINICIAN/PRESIDENT
Credential: LCSW
Phone: 505-328-9448