Provider Demographics
NPI:1053838144
Name:BROSH, ANGELA JOY (LSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:JOY
Last Name:BROSH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7042 DOMINICAN DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1200
Mailing Address - Country:US
Mailing Address - Phone:937-654-9623
Mailing Address - Fax:
Practice Address - Street 1:6000 PHILADELPHIA DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-3052
Practice Address - Country:US
Practice Address - Phone:937-277-6101
Practice Address - Fax:937-277-2962
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0029899104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker