Healthcare Provider Details

I. General information

NPI: 1548954597
Provider Name (Legal Business Name): ANGELIA DENISE GLASS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 06/05/2023
Certification Date: 06/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 S STATE ST
DOVER DE
19901-5148
US

IV. Provider business mailing address

1609 S STATE ST
DOVER DE
19901-5148
US

V. Phone/Fax

Practice location:
  • Phone: 302-257-3135
  • Fax:
Mailing address:
  • Phone: 302-257-3135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: