Provider Demographics
NPI:1730899428
Name:ADDISON, ANGELICA MONIQUE (ASW)
Entity type:Individual
Prefix:MISS
First Name:ANGELICA
Middle Name:MONIQUE
Last Name:ADDISON
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 BUENA VISTA AVE APT 311
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-1954
Mailing Address - Country:US
Mailing Address - Phone:510-228-2070
Mailing Address - Fax:
Practice Address - Street 1:525 21ST ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1605
Practice Address - Country:US
Practice Address - Phone:510-587-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110684104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker