Healthcare Provider Details

I. General information

NPI: 1841830833
Provider Name (Legal Business Name): JEMIMA ANGLADE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2020
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 FRANKLIN ST NE
WASHINGTON DC
20018-2000
US

IV. Provider business mailing address

2508 BELAIR DR
BOWIE MD
20715-2607
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-3012
  • Fax:
Mailing address:
  • Phone: 407-394-4449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: