Provider Demographics
NPI:1083319065
Name:IRVIN, ANGELA KAY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:KAY
Last Name:IRVIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 LAKE WORTH RD STE 219
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2966
Mailing Address - Country:US
Mailing Address - Phone:561-328-8420
Mailing Address - Fax:561-828-2884
Practice Address - Street 1:6801 LAKE WORTH RD STE 219
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33467-2966
Practice Address - Country:US
Practice Address - Phone:561-328-8420
Practice Address - Fax:561-828-2884
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI615011666221OtherDRIVERS LICENSE