Provider Demographics
NPI:1003852286
Name:ANGEL FOUNDATION
Entity Type:Organization
Organization Name:ANGEL FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:F
Authorized Official - Last Name:BROY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C, BCD
Authorized Official - Phone:410-467-0507
Mailing Address - Street 1:100 W 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5602
Mailing Address - Country:US
Mailing Address - Phone:410-467-0507
Mailing Address - Fax:410-467-2413
Practice Address - Street 1:100 W 22ND ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5602
Practice Address - Country:US
Practice Address - Phone:410-467-0507
Practice Address - Fax:410-467-2413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0380101YM0800X
MD091141041C0700X
MD040581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty