Provider Demographics
NPI:1447464383
Name:SUAREZ, ANGELE' NICOLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ANGELE'
Middle Name:NICOLE
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANGELE
Other - Middle Name:
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSSW
Mailing Address - Street 1:6302 CULVERT DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-4839
Mailing Address - Country:US
Mailing Address - Phone:831-236-2115
Mailing Address - Fax:
Practice Address - Street 1:1961 LAS PLUMAS AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95133-1741
Practice Address - Country:US
Practice Address - Phone:408-251-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW789611041C0700X
VA09040089251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100509104Medicaid