Provider Demographics
NPI:1003008202
Name:OLIVER, ANGELA D (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:D
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:EL PRADO
Mailing Address - State:NM
Mailing Address - Zip Code:87529-0278
Mailing Address - Country:US
Mailing Address - Phone:575-751-9858
Mailing Address - Fax:575-613-1506
Practice Address - Street 1:244 TUNE DRIVE
Practice Address - Street 2:
Practice Address - City:EL PRADO
Practice Address - State:NM
Practice Address - Zip Code:87529
Practice Address - Country:US
Practice Address - Phone:575-751-9858
Practice Address - Fax:575-751-9858
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-06235101YM0800X
NMC-062351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM99881365Medicaid