Provider Demographics
NPI:1801409123
Name:BARTLETT, ANGEL (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2357 BROOKMOOR LN
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-4083
Mailing Address - Country:US
Mailing Address - Phone:757-602-6008
Mailing Address - Fax:
Practice Address - Street 1:2357 BROOKMOOR LN
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-4083
Practice Address - Country:US
Practice Address - Phone:757-602-6008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040122311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical