Provider Demographics
NPI:1366539074
Name:HENRY, ANGELA MARIE (BA, MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARIE
Last Name:HENRY
Suffix:
Gender:F
Credentials:BA, MSW, LCSW
Other - Prefix:
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Mailing Address - Street 1:100 NAVARRE PL
Mailing Address - Street 2:STE: 5550
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1156
Mailing Address - Country:US
Mailing Address - Phone:574-647-2550
Mailing Address - Fax:574-647-7191
Practice Address - Street 1:1801 BADER AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-2523
Practice Address - Country:US
Practice Address - Phone:574-233-5595
Practice Address - Fax:574-282-1770
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN34006296A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical