Healthcare Provider Details

I. General information

NPI: 1558594655
Provider Name (Legal Business Name): ANGELA LORRAINE ANDERSON M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 LONG BEACH BLVD SUITE 700
LONG BEACH CA
90807-2011
US

IV. Provider business mailing address

PO BOX 60637
PASADENA CA
91116-6637
US

V. Phone/Fax

Practice location:
  • Phone: 310-783-4677
  • Fax:
Mailing address:
  • Phone: 310-370-2613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW67112
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number26455
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: