Provider Demographics
NPI:1457085789
Name:BRONES, ANGELA LARAE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:LARAE
Last Name:BRONES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 15TH STREET A
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6210
Mailing Address - Country:US
Mailing Address - Phone:773-706-3836
Mailing Address - Fax:
Practice Address - Street 1:2525 24TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-5395
Practice Address - Country:US
Practice Address - Phone:309-779-5044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA113869104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker