Provider Demographics
NPI:1780033944
Name:MAURO-CONRAD, ANGELINA (LICSW)
Entity type:Individual
Prefix:
First Name:ANGELINA
Middle Name:
Last Name:MAURO-CONRAD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 471
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MA
Mailing Address - Zip Code:01936-0471
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:199 ROSEWOOD DR
Practice Address - Street 2:SUITE 210
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1398
Practice Address - Country:US
Practice Address - Phone:978-867-7813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10249931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMA P21162Medicare PIN