Provider Demographics
NPI:1740202001
Name:HAHN-MOWRY, ANGELA JO (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:JO
Last Name:HAHN-MOWRY
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 1:1243 SHED RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15522-8584
Mailing Address - Country:US
Mailing Address - Phone:814-623-5166
Mailing Address - Fax:814-623-3460
Practice Address - Street 1:1243 SHED RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522-8584
Practice Address - Country:US
Practice Address - Phone:814-623-5166
Practice Address - Fax:814-623-3460
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW152841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000001750049Medicaid
PA123535Medicare ID - Type Unspecified
PA1000001750049Medicaid