MEDICARE: ANGELA MARIE PROCALAMOS LCSW

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	68063	TX

General Provider Information

NPI Number	:	1609724780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA MARIE PROCALAMOS LCSW

Provider Business Mailing Address
First Line	:	5900 BALCONES DR STE 100
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-4298
Country	:	US
Telephone Number	:	512-677-2658
Fax Number	:

Provider Business Practice Location Address
First Line	:	704 GARDEN MEADOW DR
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78628-2924
Country	:	US
Telephone Number	:	512-677-2658
Fax Number	:

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

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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