Provider Demographics
NPI:1063181584
Name:LUNA, ANGELA CAMILLE (LMSW)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:CAMILLE
Last Name:LUNA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:CAMILLE
Other - Last Name:VARELA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 22242
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87502-2242
Mailing Address - Country:US
Mailing Address - Phone:505-570-0919
Mailing Address - Fax:
Practice Address - Street 1:560 S CAMINO DEL PUEBLO
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-5803
Practice Address - Country:US
Practice Address - Phone:505-404-5312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-117811041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool