Provider Demographics
NPI:1891500161
Name:BRANNAN, ANGELA R (MSW,LCSW)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:R
Last Name:BRANNAN
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 GLENVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53213-3323
Mailing Address - Country:US
Mailing Address - Phone:414-581-3210
Mailing Address - Fax:
Practice Address - Street 1:207 E BUFFALO ST STE 324
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-5712
Practice Address - Country:US
Practice Address - Phone:414-581-3210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1064-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical