Provider Demographics
NPI:1083497176
Name:ANGELUCCI, AMY (EDS)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:ANGELUCCI
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 REDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-7611
Mailing Address - Country:US
Mailing Address - Phone:859-608-3713
Mailing Address - Fax:
Practice Address - Street 1:120 REDWOOD DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-7611
Practice Address - Country:US
Practice Address - Phone:859-608-3713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALACA-0118-2782103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool