Provider Demographics
NPI:1922319540
Name:MADISON, ANGELA K (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:K
Last Name:MADISON
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 1:645 S ROGERS ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2353
Mailing Address - Country:US
Mailing Address - Phone:800-344-8802
Mailing Address - Fax:812-378-8367
Practice Address - Street 1:1530 N COMMERCE WEST DR
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:IN
Practice Address - Zip Code:47240-3205
Practice Address - Country:US
Practice Address - Phone:812-663-7057
Practice Address - Fax:812-378-8367
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN266180772Medicare PIN