Provider Demographics
NPI:1992075543
Name:RICHARD, ANGIE RACHEL (LCSW)
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:RACHEL
Last Name:RICHARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 BERLIN PLANK RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-2069
Mailing Address - Country:US
Mailing Address - Phone:814-701-2898
Mailing Address - Fax:814-701-2917
Practice Address - Street 1:485 BERLIN PLANK RD
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-2069
Practice Address - Country:US
Practice Address - Phone:814-701-2898
Practice Address - Fax:814-701-2917
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1041C0700X
PACW0187491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA652680173Medicare UPIN