Provider Demographics
NPI:1063401230
Name:ANGELL, JANE ELIZABETH (MSW LCSW)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:ELIZABETH
Last Name:ANGELL
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 E COOLEY ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-5103
Mailing Address - Country:US
Mailing Address - Phone:928-537-0370
Mailing Address - Fax:928-537-1189
Practice Address - Street 1:1141 E COOLEY ST
Practice Address - Street 2:SUITE E
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-5103
Practice Address - Country:US
Practice Address - Phone:928-537-0370
Practice Address - Fax:928-537-1189
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-106751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ78396Medicare ID - Type Unspecified