Provider Demographics
NPI:1740910025
Name:LEE, ANGELA DEANINE (MSW)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:DEANINE
Last Name:LEE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 175TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2057
Mailing Address - Country:US
Mailing Address - Phone:773-998-9948
Mailing Address - Fax:
Practice Address - Street 1:905 175TH ST STE 300
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2057
Practice Address - Country:US
Practice Address - Phone:773-998-9948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker