Provider Demographics
NPI:1073330577
Name:SMITH, ANGELICA MARIA
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:MARIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4860 N MILE 3 1/2 W
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78599-5551
Mailing Address - Country:US
Mailing Address - Phone:956-536-0170
Mailing Address - Fax:
Practice Address - Street 1:1009 S UTAH AVE STE A
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-5588
Practice Address - Country:US
Practice Address - Phone:956-520-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106970104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker