Provider Demographics
NPI:1164127684
Name:NEAL, ANGELA KATHRYN (LICSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:KATHRYN
Last Name:NEAL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7256 BODKIN WAY
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:MD
Mailing Address - Zip Code:21774-6967
Mailing Address - Country:US
Mailing Address - Phone:202-360-0647
Mailing Address - Fax:
Practice Address - Street 1:7256 BODKIN WAY
Practice Address - Street 2:
Practice Address - City:NEW MARKET
Practice Address - State:MD
Practice Address - Zip Code:21774-6967
Practice Address - Country:US
Practice Address - Phone:202-360-0647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500794291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical