Healthcare Provider Details

I. General information

NPI: 1003852286
Provider Name (Legal Business Name): ANGEL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W 22ND ST
BALTIMORE MD
21218-5602
US

IV. Provider business mailing address

100 W 22ND ST
BALTIMORE MD
21218-5602
US

V. Phone/Fax

Practice location:
  • Phone: 410-467-0507
  • Fax: 410-467-2413
Mailing address:
  • Phone: 410-467-0507
  • Fax: 410-467-2413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC0380
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09114
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number04058
License Number StateMD

VIII. Authorized Official

Name: MS. SHARON F. BROY
Title or Position: CLINICAL DIRECTOR
Credential: LCSW-C, BCD
Phone: 410-467-0507