Provider Demographics
NPI:1700520889
Name:SCHUCKHARDT, ANGELA ELIZABETH (LCSW)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:ELIZABETH
Last Name:SCHUCKHARDT
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 1:147 PARK ST
Mailing Address - Street 2:
Mailing Address - City:ARCADE
Mailing Address - State:NY
Mailing Address - Zip Code:14009-1512
Mailing Address - Country:US
Mailing Address - Phone:716-474-3187
Mailing Address - Fax:
Practice Address - Street 1:147 PARK ST
Practice Address - Street 2:
Practice Address - City:ARCADE
Practice Address - State:NY
Practice Address - Zip Code:14009-1512
Practice Address - Country:US
Practice Address - Phone:716-474-3187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0872301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical