Healthcare Provider Details

I. General information

NPI: 1487866257
Provider Name (Legal Business Name): ANGELICA MARIA EXINIA MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 10/16/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 EAST 7TH STREET
HYDRO OK
73048-3918
US

IV. Provider business mailing address

534 N COWLES AVE
HYDRO OK
73048-8778
US

V. Phone/Fax

Practice location:
  • Phone: 405-823-5291
  • Fax:
Mailing address:
  • Phone: 405-823-5291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6345
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: