Healthcare Provider Details

I. General information

NPI: 1790203479
Provider Name (Legal Business Name): ANNA VIGIL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2017
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 S MELENDRES ST
LAS CRUCES NM
88005-2805
US

IV. Provider business mailing address

111 CADENA ST
MESQUITE NM
88048-9348
US

V. Phone/Fax

Practice location:
  • Phone: 575-636-7117
  • Fax:
Mailing address:
  • Phone: 575-636-7117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM10080
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC12017
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: