Provider Demographics
NPI:1669736096
Name:SANCHEZ, ANGELICA MARIA (LCSW)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:MARIA
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANGELICA
Other - Middle Name:MARIA
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, CADCI
Mailing Address - Street 1:1217 NE BURNSIDE RD STE 401B
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-5705
Mailing Address - Country:US
Mailing Address - Phone:503-714-6426
Mailing Address - Fax:503-912-7019
Practice Address - Street 1:1217 NE BURNSIDE RD STE 401B
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5705
Practice Address - Country:US
Practice Address - Phone:503-714-6426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-29
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13-12-25101YA0400X
ORL63671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500671951Medicaid