Basic Information
Provider Information
NPI: 1003140294
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ANGEL
FirstName: HANNAH
MiddleName: DAWN
NamePrefix: MISS
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 800 CUMMINGS CTR
Address2: SUITE 266T
City: BEVERLY
State: MA
PostalCode: 019156175
CountryCode: US
TelephoneNumber: 9789211190
FaxNumber: 9789273724
Practice Location
Address1: 800 CUMMINGS CTR
Address2: SUITE 266T
City: BEVERLY
State: MA
PostalCode: 019156175
CountryCode: US
TelephoneNumber: 9789211190
FaxNumber: 9789273724
Other Information
ProviderEnumerationDate: 09/22/2009
LastUpdateDate: 09/22/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X  Y Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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