Provider Demographics
NPI:1699935148
Name:MASCHARKA, ANGELA ROSE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:ROSE
Last Name:MASCHARKA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:ROSE
Other - Last Name:MILLER MASCHARKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2823 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61101-3542
Mailing Address - Country:US
Mailing Address - Phone:815-494-8665
Mailing Address - Fax:815-968-4656
Practice Address - Street 1:2823 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61101-3542
Practice Address - Country:US
Practice Address - Phone:815-968-5342
Practice Address - Fax:815-968-4656
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490081281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical