Provider Demographics
NPI:1356436737
Name:TRENZ, ANGELA (LCSW)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:TRENZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 ROCKVILLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-2210
Mailing Address - Country:US
Mailing Address - Phone:516-868-9880
Mailing Address - Fax:516-868-9880
Practice Address - Street 1:1740 ROCKVILLE DRIVE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-2210
Practice Address - Country:US
Practice Address - Phone:516-868-9880
Practice Address - Fax:516-868-9880
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR040028-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN75731Medicare ID - Type Unspecified