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General NPI Number Information
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NPI Number | 1154679512
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Entity Type | Individual
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Provider Name | ANGELA ROSE TYRONE LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/16/2012
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Last Update Date | 01/22/2021
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Provider Practice Location Address
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Address Line | 28315 S. FROST RD.
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City | LIVINGSTON
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State | LA
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Zip | 70754
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Country | US
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Telephone | 225-283-1356
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Fax | 225-686-2962
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Provider Business Mailing Address
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Address Line | 406 HEWITT RD
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City | HAMMOND
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State | LA
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Zip | 70403-6002
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Country | US
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Telephone | 985-902-7643
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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 | 3900
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License Number State | LA
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