MEDICARE: ANGENIQUE CHEREE HOWARD

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	103T00000X	Psychologist	A7443052	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4700	OTHER		MENTAL HEALTH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487115036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGENIQUE CHEREE HOWARD

Provider Business Mailing Address
First Line	:	1234 E CLIVEDEN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-3946
Country	:	US
Telephone Number	:	215-960-5066
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 LEIPER ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124-3223
Country	:	US
Telephone Number	:	215-960-5066
Fax Number	:

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

Provider Enumeration Date	:	03/27/2019
Last Update Date	:	03/27/2019

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Directions to “ ANGENIQUE CHEREE HOWARD ” Practice Location

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