Provider Demographics
NPI:1275940470
Name:ANGELOS, EDNA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:
Last Name:ANGELOS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 COLUMBIA TPKE
Mailing Address - Street 2:SUITE
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-2113
Mailing Address - Country:US
Mailing Address - Phone:973-400-9611
Mailing Address - Fax:
Practice Address - Street 1:147 COLUMBIA TPKE
Practice Address - Street 2:SUITE 307
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932
Practice Address - Country:US
Practice Address - Phone:973-400-9611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-20
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00633500101YP2500X
NJ37AC00207400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional