Provider Demographics
NPI:1730751397
Name:AGUILAR, MELISSA (LMSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 UNSER BLVD SE STE 103
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-4660
Mailing Address - Country:US
Mailing Address - Phone:505-404-0554
Mailing Address - Fax:505-393-4525
Practice Address - Street 1:500 UNSER BLVD SE STE 103
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-4660
Practice Address - Country:US
Practice Address - Phone:505-404-0554
Practice Address - Fax:505-393-4525
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-119931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical