MEDICARE: KAREN DIANE ANGELOFF 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	1041C0700X	Clinical Social Worker	0904006479	VA

General Provider Information

NPI Number	:	1467707497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN DIANE ANGELOFF LCSW

Provider Business Mailing Address
First Line	:	14314 DEER MEADOW DR
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23112-4132
Country	:	US
Telephone Number	:	804-243-0609
Fax Number	:

Provider Business Practice Location Address
First Line	:	6603 IRONGATE SQ
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23234-6081
Country	:	US
Telephone Number	:	804-743-0960
Fax Number	:

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

Provider Enumeration Date	:	07/16/2012
Last Update Date	:	09/15/2021

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