Provider Demographics
NPI:1164953261
Name:ANGULO, ELBANY E (BS)
Entity Type:Individual
Prefix:
First Name:ELBANY
Middle Name:E
Last Name:ANGULO
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10630 NW 88TH ST
Mailing Address - Street 2:#203
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-3466
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10630 NW 88TH ST
Practice Address - Street 2:#203
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-3466
Practice Address - Country:US
Practice Address - Phone:786-972-2940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YS0200X, 103K00000X, 106E00000X
FLMH20897101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst