Provider Demographics
NPI:1952683484
Name:BRATHWAITE, ANGELIQUE ALISIA (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:ANGELIQUE
Middle Name:ALISIA
Last Name:BRATHWAITE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 ANNAPOLIS RD APT 801
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-2020
Mailing Address - Country:US
Mailing Address - Phone:410-504-2776
Mailing Address - Fax:
Practice Address - Street 1:5800 ANNAPOLIS RD APT 801
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-2020
Practice Address - Country:US
Practice Address - Phone:410-504-2776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-11
Last Update Date:2011-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD171661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical