Provider Demographics
NPI:1164165452
Name:BADILLO, ANGELICA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:ANGELICA
Middle Name:
Last Name:BADILLO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909B MILL ALY
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-1610
Mailing Address - Country:US
Mailing Address - Phone:570-730-4211
Mailing Address - Fax:
Practice Address - Street 1:317 DARTMOUTH DR.
Practice Address - Street 2:
Practice Address - City:MARSHALLS CREEK
Practice Address - State:PA
Practice Address - Zip Code:18335
Practice Address - Country:US
Practice Address - Phone:570-730-4211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW138005101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health