Provider Demographics
NPI:1801075601
Name:ANGELAKIS, JOAN (LCSW)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:ANGELAKIS
Suffix:
Gender:F
Credentials:LCSW
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 2
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04978-0002
Mailing Address - Country:US
Mailing Address - Phone:207-462-5900
Mailing Address - Fax:207-362-6111
Practice Address - Street 1:28 MERRY LN
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:ME
Practice Address - Zip Code:04978-0002
Practice Address - Country:US
Practice Address - Phone:207-462-5900
Practice Address - Fax:207-362-6111
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC37401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
469007OtherVALUE OPTIONS
047966OtherANTHEM
1040884OtherCIGNA
0007217022OtherAETNA
1040884OtherCIGNA