MEDICARE: DR. ANGEL WINDHAM LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	44SL05258500	NJ

General Provider Information

NPI Number	:	1194920306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGEL WINDHAM LCSW

Provider Business Mailing Address
First Line	:	4499 STATE 27 BUILDING 1 FIRST FLOOR
Second Line	:
City	:	PRINCETON
State	:	NJ
Zip	:	08540
Country	:	US
Telephone Number	:	732-723-8343
Fax Number	:	732-358-0933

Provider Business Practice Location Address
First Line	:	4499 STATE 27 BUILDING 1 FIRST FLOOR
Second Line	:
City	:	PRINCETON
State	:	NJ
Zip	:	08540
Country	:	US
Telephone Number	:	732-723-8343
Fax Number	:	732-358-0933

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	06/04/2026

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