Healthcare Provider Details

I. General information

NPI: 1497052120
Provider Name (Legal Business Name): ANGELA M SLUZALIS LCSWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2011
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 TIGER WAY
BOONSBORO MD
21713-2060
US

IV. Provider business mailing address

210 TIGER WAY
BOONSBORO MD
21713-2060
US

V. Phone/Fax

Practice location:
  • Phone: 301-432-5202
  • Fax: 855-959-2453
Mailing address:
  • Phone: 301-432-5202
  • Fax: 855-959-2453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14962
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14962
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: