Provider Demographics
NPI:1518165786
Name:RENO, ANGELA NICOLE (LISW)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:NICOLE
Last Name:RENO
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:NICOLE
Other - Last Name:COPOER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2621 DRYDEN RD STE 302
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1661
Mailing Address - Country:US
Mailing Address - Phone:314-607-7787
Mailing Address - Fax:
Practice Address - Street 1:829 S GETTYSBURG AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3569
Practice Address - Country:US
Practice Address - Phone:314-607-7787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
OHI.2002228104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical