Provider Demographics
NPI:1093604241
Name:SIVADO, ANGEL MARIE (CADC A1)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:MARIE
Last Name:SIVADO
Suffix:
Gender:F
Credentials:CADC A1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 CRUMS LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-4471
Mailing Address - Country:US
Mailing Address - Phone:502-281-1747
Mailing Address - Fax:
Practice Address - Street 1:1501 ALETHA DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-1111
Practice Address - Country:US
Practice Address - Phone:502-628-7469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY281166101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)