Provider Demographics
NPI:1801210372
Name:BROOKS-GREEN, ANGELA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:BROOKS-GREEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:BROOKS-GREEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CSW
Mailing Address - Street 1:5278 JONES RD
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-9766
Mailing Address - Country:US
Mailing Address - Phone:270-313-6069
Mailing Address - Fax:270-926-0817
Practice Address - Street 1:5278 JONES RD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-9766
Practice Address - Country:US
Practice Address - Phone:270-313-6069
Practice Address - Fax:270-926-0817
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical