Provider Demographics
NPI:1326462896
Name:SHERWOOD, ANGELA (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:SHERWOOD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 SW 5TH AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5037
Mailing Address - Country:US
Mailing Address - Phone:208-816-7378
Mailing Address - Fax:208-816-7385
Practice Address - Street 1:429 SW 5TH AVE
Practice Address - Street 2:STE 110
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5037
Practice Address - Country:US
Practice Address - Phone:208-816-7378
Practice Address - Fax:208-816-7385
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-355981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical