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General NPI Number Information
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NPI Number | 1033406962
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Entity Type | Individual
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Provider Name | ANGELA M BOONE LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 06/29/2011
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Last Update Date | 04/09/2021
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Provider Practice Location Address
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Address Line | 308 GATEHOUSE LN UNIT D
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City | ODENTON
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State | MD
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Zip | 21113-2689
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Country | US
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Telephone | 443-214-8221
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 56
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City | ODENTON
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State | MD
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Zip | 21113-0056
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Country | US
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Telephone | 443-214-8221
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904007353
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 16065
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License Number State | MD
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