Basic Information
| Provider Information | |||||||||
| NPI: | 1538744693 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BHOWAL | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | MADISON | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11102 106TH ST | ||||||||
| Address2: | |||||||||
| City: | OZONE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114172654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9172730267 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10470 QUEENS BLVD FL 2 | ||||||||
| Address2: | |||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113753638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182756010 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2021 | ||||||||
| LastUpdateDate: | 10/29/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 08/24/2021 | ||||||||
| NPIReactivationDate: | 10/29/2021 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 114308 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.