Provider Demographics
NPI:1407139975
Name:DAILEY, ANGELA DAWN (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:DAWN
Last Name:DAILEY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 264
Mailing Address - Street 2:
Mailing Address - City:PARKER CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47368-0264
Mailing Address - Country:US
Mailing Address - Phone:765-289-5437
Mailing Address - Fax:765-741-5269
Practice Address - Street 1:3700 W KILGORE AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-4810
Practice Address - Country:US
Practice Address - Phone:765-289-5437
Practice Address - Fax:765-741-5269
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
IN34006846A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12289524OtherCAQH PROVIDER NUMBER