Provider Demographics
NPI:1316699762
Name:SIRGO, ANGELE MARIE (LCSW-BACS, CCM)
Entity type:Individual
Prefix:
First Name:ANGELE
Middle Name:MARIE
Last Name:SIRGO
Suffix:
Gender:F
Credentials:LCSW-BACS, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 28TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-1325
Mailing Address - Country:US
Mailing Address - Phone:504-460-9773
Mailing Address - Fax:
Practice Address - Street 1:1770 HIGHWAY 59
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-1960
Practice Address - Country:US
Practice Address - Phone:985-231-3288
Practice Address - Fax:985-231-3288
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA60791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ037115Medicaid