Provider Demographics
NPI:1801667225
Name:O'BRIEN, ANGELA JO (LSW)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:JO
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 W CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-1546
Mailing Address - Country:US
Mailing Address - Phone:570-850-6158
Mailing Address - Fax:
Practice Address - Street 1:8 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-1546
Practice Address - Country:US
Practice Address - Phone:570-850-6158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW140347104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker