Healthcare Provider Details

I. General information

NPI: 1104451137
Provider Name (Legal Business Name): ABIGAIL MARROQUIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 W MARTIN ST # MS 49-2
SAN ANTONIO TX
78207-0903
US

IV. Provider business mailing address

11710 PARLIAMENT ST APT 403
SAN ANTONIO TX
78213-1166
US

V. Phone/Fax

Practice location:
  • Phone: 210-358-8255
  • Fax:
Mailing address:
  • Phone: 956-560-2304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number61276
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: