Healthcare Provider Details

I. General information

NPI: 1467707497
Provider Name (Legal Business Name): KAREN DIANE ANGELOFF LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6603 IRONGATE SQ
NORTH CHESTERFIELD VA
23234-6081
US

IV. Provider business mailing address

14314 DEER MEADOW DR
MIDLOTHIAN VA
23112-4132
US

V. Phone/Fax

Practice location:
  • Phone: 804-743-0960
  • Fax:
Mailing address:
  • Phone: 804-243-0609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904006479
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: