Provider Demographics
NPI:1417283375
Name:BURLOCK, ANGELA M (LMSW-CC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:BURLOCK
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 MILITARY ST STE 3
Mailing Address - Street 2:
Mailing Address - City:HOULTON
Mailing Address - State:ME
Mailing Address - Zip Code:04730-2508
Mailing Address - Country:US
Mailing Address - Phone:207-538-2416
Mailing Address - Fax:207-521-0900
Practice Address - Street 1:144 MILITARY ST STE 3
Practice Address - Street 2:
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-2508
Practice Address - Country:US
Practice Address - Phone:207-538-2416
Practice Address - Fax:207-521-0900
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical