Provider Demographics
NPI:1770761926
Name:DAUGHERTY, ANGELA L (MSSA, LISW)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:L
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:MSSA, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PARKER CT
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-1141
Mailing Address - Country:US
Mailing Address - Phone:440-286-1553
Mailing Address - Fax:440-286-1318
Practice Address - Street 1:100 PARKER CT
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-1141
Practice Address - Country:US
Practice Address - Phone:440-286-1553
Practice Address - Fax:440-286-1318
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00098991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical