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General NPI Number Information
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NPI Number | 1043086705
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Entity Type | Individual
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Provider Name | TALLIBAH ANGELA POWELL LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/04/2023
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Last Update Date | 01/23/2026
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Provider Practice Location Address
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Address Line | 155 WILLOWBROOK BLVD STE 110
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City | WAYNE
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State | NJ
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Zip | 07470-7033
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Country | US
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Telephone | 862-277-0584
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Fax |
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Provider Business Mailing Address
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Address Line | 398 HIGH ST FL 1
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City | ORANGE
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State | NJ
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Zip | 07050-1921
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Country | US
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Telephone | 973-519-7609
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 099943-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 44SL06595600
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License Number State | NJ
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