Healthcare Provider Details

I. General information

NPI: 1801075601
Provider Name (Legal Business Name): JOAN ANGELAKIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 06/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 MERRY LN
SMITHFIELD ME
04978-0002
US

IV. Provider business mailing address

PO BOX 2
SMITHFIELD ME
04978-0002
US

V. Phone/Fax

Practice location:
  • Phone: 207-462-5900
  • Fax: 207-362-6111
Mailing address:
  • Phone: 207-462-5900
  • Fax: 207-362-6111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC3740
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier469007
Identifier TypeOTHER
Identifier State
Identifier IssuerVALUE OPTIONS
# 2
Identifier047966
Identifier TypeOTHER
Identifier State
Identifier IssuerANTHEM
# 3
Identifier1040884
Identifier TypeOTHER
Identifier State
Identifier IssuerCIGNA
# 4
Identifier0007217022
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: