Provider Demographics
NPI:1053901488
Name:BROWN, ANGELLA (REGISTERED INTERN)
Entity type:Individual
Prefix:
First Name:ANGELLA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:REGISTERED INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 CYPRESS WALK TER
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-3607
Mailing Address - Country:US
Mailing Address - Phone:407-552-9944
Mailing Address - Fax:
Practice Address - Street 1:4699 N STATE ROAD 7 STE B1
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-5870
Practice Address - Country:US
Practice Address - Phone:407-552-9944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20518101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health