Provider Demographics
NPI:1710517693
Name:MUSAWWIR, ANGELENE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELENE
Middle Name:
Last Name:MUSAWWIR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3428 TABORA DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-5442
Mailing Address - Country:US
Mailing Address - Phone:925-565-9272
Mailing Address - Fax:
Practice Address - Street 1:2810 LONE TREE WAY STE 9
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-4956
Practice Address - Country:US
Practice Address - Phone:925-565-9272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA644211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty