Healthcare Provider Details

I. General information

NPI: 1184536054
Provider Name (Legal Business Name): ANGELA LAVERY LCSW, PHD, FT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

873 E BALTIMORE PIKE # 1138
KENNETT SQUARE PA
19348-1864
US

IV. Provider business mailing address

873 E BALTIMORE PIKE # 1138
KENNETT SQUARE PA
19348-1864
US

V. Phone/Fax

Practice location:
  • Phone: 610-947-0925
  • Fax:
Mailing address:
  • Phone: 610-947-0925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW018979
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: