Provider Demographics
NPI:1003143694
Name:AGUASVIVAS, ANGEL M (MHC)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:M
Last Name:AGUASVIVAS
Suffix:
Gender:M
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 WILES RD STE 105
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2063
Mailing Address - Country:US
Mailing Address - Phone:954-341-1022
Mailing Address - Fax:
Practice Address - Street 1:7501 WILES RD STE 105
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-2063
Practice Address - Country:US
Practice Address - Phone:954-341-1022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10008101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health