Provider Demographics
NPI:1821169616
Name:MAES, ANGELA P (LISW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:P
Last Name:MAES
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 CARLISLE BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4905
Mailing Address - Country:US
Mailing Address - Phone:505-842-9911
Mailing Address - Fax:505-254-9911
Practice Address - Street 1:1803 CARLISLE BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4905
Practice Address - Country:US
Practice Address - Phone:505-842-9911
Practice Address - Fax:505-254-9911
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-050651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM36723550Medicaid