Healthcare Provider Details

I. General information

NPI: 1346640026
Provider Name (Legal Business Name): ANGELYNN MARIE HERMES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2014
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4764 E SUNRISE DR UNIT 430
TUCSON AZ
85718-4535
US

IV. Provider business mailing address

4764 E SUNRISE DR UNIT 430
TUCSON AZ
85718-4535
US

V. Phone/Fax

Practice location:
  • Phone: 520-235-6656
  • Fax:
Mailing address:
  • Phone: 520-235-6656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19681
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1140818
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number88997
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: