Provider Demographics
NPI:1730487786
Name:SONG, ANGELA (LCSW)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:SONG
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 1:95-277 AHIKU ST APT 90
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-4109
Mailing Address - Country:US
Mailing Address - Phone:773-368-0285
Mailing Address - Fax:
Practice Address - Street 1:95-277 AHIKU ST APT 90
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-4109
Practice Address - Country:US
Practice Address - Phone:773-368-0285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0144901041C0700X
HI42271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical