Provider Demographics
NPI:1942597505
Name:AGUILAR, CARMEN MARIA (LSCSW)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:MARIA
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:DEL CARMEN
Other - Last Name:OJEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2750 S GLENN AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67217-1843
Mailing Address - Country:US
Mailing Address - Phone:316-807-5055
Mailing Address - Fax:
Practice Address - Street 1:2312 S MERIDIAN AVE STE 102
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213
Practice Address - Country:US
Practice Address - Phone:316-807-5055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS056111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30004569780001Medicaid
KS200733820BMedicaid