Provider Demographics
NPI:1063723393
Name:CHEW, ANGELA NIKOL (LCSW)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:NIKOL
Last Name:CHEW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:NIKOL
Other - Last Name:HARDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:PA
Mailing Address - Zip Code:15853-1939
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:PA
Practice Address - Zip Code:15853-1939
Practice Address - Country:US
Practice Address - Phone:814-776-0250
Practice Address - Fax:814-776-1470
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0165621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100000504Medicaid