Provider Demographics
NPI:1013463264
Name:BARAN, ANGELIQUE
Entity Type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:
Last Name:BARAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELIQUE
Other - Middle Name:
Other - Last Name:BARAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1113 KING WAY
Mailing Address - Street 2:
Mailing Address - City:BREINIGSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18031-1480
Mailing Address - Country:US
Mailing Address - Phone:610-928-7104
Mailing Address - Fax:
Practice Address - Street 1:4210 INDEPENDENCE DRIVE
Practice Address - Street 2:
Practice Address - City:SCHNECKSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18078
Practice Address - Country:US
Practice Address - Phone:610-769-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0147511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical