Provider Demographics
NPI:1760737464
Name:WULF, ANGELA MARGARET (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARGARET
Last Name:WULF
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 1:4939 S 118TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-2213
Mailing Address - Country:US
Mailing Address - Phone:402-451-0787
Mailing Address - Fax:402-898-7750
Practice Address - Street 1:4939 S 118TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2213
Practice Address - Country:US
Practice Address - Phone:402-451-0787
Practice Address - Fax:402-898-7750
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3882101YM0800X
NE14041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health