Provider Demographics
NPI:1164507802
Name:MAIO, ANGELA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:MAIO
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 1:1 SECOND ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-2523
Mailing Address - Country:US
Mailing Address - Phone:856-275-6145
Mailing Address - Fax:
Practice Address - Street 1:281 ROUTE 79 N
Practice Address - Street 2:STE 109
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-1157
Practice Address - Country:US
Practice Address - Phone:856-275-6145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC007493001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
J016197OtherTRICARE
NJS15003Medicare UPIN