Provider Demographics
NPI:1477799153
Name:GALLEGOS, ANGEL F (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:F
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 67 BOX 50
Mailing Address - Street 2:RD B45B
Mailing Address - City:ANTON CHICO
Mailing Address - State:NM
Mailing Address - Zip Code:87711
Mailing Address - Country:US
Mailing Address - Phone:505-427-1276
Mailing Address - Fax:
Practice Address - Street 1:1000 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-9415
Practice Address - Country:US
Practice Address - Phone:505-454-9730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-063921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical