Provider Demographics
NPI:1710508668
Name:BIRD, ANGELA (LISW)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:BIRD
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3147 GLENDALE MILFORD RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-3134
Mailing Address - Country:US
Mailing Address - Phone:513-563-6934
Mailing Address - Fax:513-769-2622
Practice Address - Street 1:3147 GLENDALE MILFORD RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-3134
Practice Address - Country:US
Practice Address - Phone:513-563-6934
Practice Address - Fax:513-769-2622
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-01
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.25068431041C0700X
MA000226625104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker