Healthcare Provider Details

I. General information

NPI: 1396106852
Provider Name (Legal Business Name): ANGELA D METRO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2016
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8532 RAMSHIRE LN
FORT WAYNE IN
46835-4486
US

IV. Provider business mailing address

8532 RAMSHIRE LN
FORT WAYNE IN
46835-4486
US

V. Phone/Fax

Practice location:
  • Phone: 260-450-5412
  • Fax:
Mailing address:
  • Phone: 260-450-5412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34011939A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33006976A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: