Provider Demographics
NPI:1689827867
Name:ANGELL, LAURA BOOTH (LICSW)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:BOOTH
Last Name:ANGELL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41B EAGLE RUN
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-5072
Mailing Address - Country:US
Mailing Address - Phone:401-338-0150
Mailing Address - Fax:
Practice Address - Street 1:209 COTTAGE ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-3026
Practice Address - Country:US
Practice Address - Phone:401-475-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW015971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical