Provider Demographics
NPI:1356075832
Name:RICHARD, ANGELICA DANIEL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANGELICA
Middle Name:DANIEL
Last Name:RICHARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5408 GRAYSON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-7111
Mailing Address - Country:US
Mailing Address - Phone:469-964-5984
Mailing Address - Fax:
Practice Address - Street 1:4500 MERCANTILE PLAZA DR STE 307
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-4230
Practice Address - Country:US
Practice Address - Phone:817-232-9400
Practice Address - Fax:817-232-9403
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62179101Y00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor