Provider Demographics
NPI:1538744693
Name:MOHAMED, ANGELA MADISON (LMSW)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:MADISON
Last Name:MOHAMED
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MADISON
Other - Last Name:BHOWAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:44 LEWIS CT
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-1113
Mailing Address - Country:US
Mailing Address - Phone:917-273-0267
Mailing Address - Fax:
Practice Address - Street 1:10470 QUEENS BLVD FL 2
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3638
Practice Address - Country:US
Practice Address - Phone:718-275-6010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2023-10-09
Deactivation Date:2021-08-24
Deactivation Code:
Reactivation Date:2021-10-29
Provider Licenses
StateLicense IDTaxonomies
NY1143081041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical