MEDICARE: ANGELA P MAES LISW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	I-05065	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821169616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA P MAES LISW

Provider Business Mailing Address
First Line	:	1803 CARLISLE BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-4905
Country	:	US
Telephone Number	:	505-842-9911
Fax Number	:	505-254-9911

Provider Business Practice Location Address
First Line	:	1803 CARLISLE BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-4905
Country	:	US
Telephone Number	:	505-842-9911
Fax Number	:	505-254-9911

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	03/22/2011

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Directions to “ ANGELA P MAES LISW” Practice Location

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