Provider Demographics
NPI:1780736496
Name:ANGELICA, CATHLEEN VIRGINIA (MSW, CSW)
Entity type:Individual
Prefix:MS
First Name:CATHLEEN
Middle Name:VIRGINIA
Last Name:ANGELICA
Suffix:
Gender:F
Credentials:MSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 WINCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2111
Mailing Address - Country:US
Mailing Address - Phone:440-821-5590
Mailing Address - Fax:216-902-6360
Practice Address - Street 1:VA MEDICAL CENTER, GRAND JUNCTION 2121 NORTH AVENUE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501
Practice Address - Country:US
Practice Address - Phone:970-263-5062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68020152471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical