Provider Demographics
NPI:1710339932
Name:MAES, ANGELA K I (LMSW)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:K
Last Name:MAES
Suffix:I
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:K
Other - Last Name:MAES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:313 W APACHE ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-5835
Mailing Address - Country:US
Mailing Address - Phone:505-325-5321
Mailing Address - Fax:
Practice Address - Street 1:313 W APACHE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5835
Practice Address - Country:US
Practice Address - Phone:505-325-5321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-096801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical