Provider Demographics
NPI:1164567905
Name:SHAHMORADI, ANGIE M (LCSW)
Entity type:Individual
Prefix:MISS
First Name:ANGIE
Middle Name:M
Last Name:SHAHMORADI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:ANGIE
Other - Middle Name:M
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 358
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04937-0358
Mailing Address - Country:US
Mailing Address - Phone:207-453-4708
Mailing Address - Fax:207-453-7064
Practice Address - Street 1:PO BOX 358
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:ME
Practice Address - Zip Code:04937-0358
Practice Address - Country:US
Practice Address - Phone:207-453-4708
Practice Address - Fax:207-453-7064
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC174341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical