Provider Demographics
NPI:1275175515
Name:BODE, ANGELA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:BODE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:PEPPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:CMR 467 BOX 3574
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09096-0036
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AUGUSTA LOOP 2562
Practice Address - Street 2:
Practice Address - City:WIESBADEN
Practice Address - State:HESSE
Practice Address - Zip Code:65205
Practice Address - Country:DE
Practice Address - Phone:317-536-4997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099260131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical