Provider Demographics
NPI:1487733010
Name:DIMAS, MARGUERITE (MS LPCC LADAC)
Entity type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:
Last Name:DIMAS
Suffix:
Gender:F
Credentials:MS LPCC LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1482 S SAINT FRANCIS DR STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4098
Mailing Address - Country:US
Mailing Address - Phone:505-690-7881
Mailing Address - Fax:
Practice Address - Street 1:1482 S SAINT FRANCIS DR STE B
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4098
Practice Address - Country:US
Practice Address - Phone:505-690-7881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3448101YA0400X
NM3068101YP2500X
NM293082101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM76332OtherPRESBYTERIAN HEALTH PLAN
NM97483530Medicaid
NM00JK60OtherBCBS
CA550010004949OtherPACIFICARE BEH HEALTH
MN2308908OtherCIGNA BEHAVIORAL HEALTH