Provider Demographics
NPI:1699418137
Name:HIRALDO, ANGELITA BLACK (MSW)
Entity type:Individual
Prefix:
First Name:ANGELITA
Middle Name:BLACK
Last Name:HIRALDO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:ANGELITA
Other - Middle Name:BLACK
Other - Last Name:HIRALDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LITA
Mailing Address - Street 1:1126 N WYCOFF AVE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-2810
Mailing Address - Country:US
Mailing Address - Phone:971-772-0309
Mailing Address - Fax:
Practice Address - Street 1:7282 STINSON AVE STE B
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-4930
Practice Address - Country:US
Practice Address - Phone:616-619-6541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical