Provider Demographics
NPI:1861813214
Name:O'DONOGHUE, ANGELA (CSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:O'DONOGHUE
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 BYPASS RD
Mailing Address - Street 2:
Mailing Address - City:BRANDENBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40108-1605
Mailing Address - Country:US
Mailing Address - Phone:270-422-3971
Mailing Address - Fax:270-422-4886
Practice Address - Street 1:2025 BYPASS RD
Practice Address - Street 2:
Practice Address - City:BRANDENBURG
Practice Address - State:KY
Practice Address - Zip Code:40108-1605
Practice Address - Country:US
Practice Address - Phone:270-422-3971
Practice Address - Fax:270-422-4886
Is Sole Proprietor?:No
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6887104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker