Healthcare Provider Details

I. General information

NPI: 1174822811
Provider Name (Legal Business Name): MELYSSA PEARL AGEE-MARES LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2011
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5951 JEFFERSON ST NE STE C
ALBUQUERQUE NM
87109-3450
US

IV. Provider business mailing address

3824 HANOVER HILL DR
VALRICO FL
33596-7161
US

V. Phone/Fax

Practice location:
  • Phone: 505-247-4900
  • Fax:
Mailing address:
  • Phone: 505-514-6640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW19229
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-08601
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: