Healthcare Provider Details

I. General information

NPI: 1376878793
Provider Name (Legal Business Name): ANGELA COLLIER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2009
Last Update Date: 10/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 CONDOR ST
EAST BOSTON MA
02128-1305
US

IV. Provider business mailing address

130 CONDOR ST
EAST BOSTON MA
02128-1305
US

V. Phone/Fax

Practice location:
  • Phone: 617-569-6560
  • Fax: 617-569-1856
Mailing address:
  • Phone: 617-569-6560
  • Fax: 617-569-1856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number216057
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: