Provider Demographics
NPI:1003099680
Name:RITA-FARIAS, ANGELA (LCSW, LP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:RITA-FARIAS
Suffix:
Gender:F
Credentials:LCSW, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 SAMOSA HILL CIR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-4935
Mailing Address - Country:US
Mailing Address - Phone:646-241-2063
Mailing Address - Fax:
Practice Address - Street 1:1 OAKWOOD DRIVE SUITE 19
Practice Address - Street 2:
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-1921
Practice Address - Country:US
Practice Address - Phone:646-241-2063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000822102L00000X
NY0709781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY070978-1OtherLCSW