Provider Demographics
NPI:1710067343
Name:PITSENBERGER, ANGELA L (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:L
Last Name:PITSENBERGER
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 1:155 E IROQUOIS ST
Mailing Address - Street 2:PO BOX 356
Mailing Address - City:SHELDON
Mailing Address - State:IL
Mailing Address - Zip Code:60966-8187
Mailing Address - Country:US
Mailing Address - Phone:815-228-3025
Mailing Address - Fax:
Practice Address - Street 1:155 E IROQUOIS ST
Practice Address - Street 2:
Practice Address - City:SHELDON
Practice Address - State:IL
Practice Address - Zip Code:60966-8187
Practice Address - Country:US
Practice Address - Phone:815-228-3025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
IL1490123771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor