Provider Demographics
NPI:1346258415
Name:DEMAIO, ANGELA C (LCSW, LISAC)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:C
Last Name:DEMAIO
Suffix:
Gender:F
Credentials:LCSW, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1339 E FORT LOWELL RD
Mailing Address - Street 2:APT. D
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-2217
Mailing Address - Country:US
Mailing Address - Phone:520-323-2448
Mailing Address - Fax:
Practice Address - Street 1:5380 E KACHINA ST
Practice Address - Street 2:BLDG. 4220
Practice Address - City:DAVIS MONTHAN AFB
Practice Address - State:AZ
Practice Address - Zip Code:85707-4923
Practice Address - Country:US
Practice Address - Phone:520-228-2104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-10968101YA0400X
AZLCSW-113121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical