Provider Demographics
NPI:1396019758
Name:BREEN, ANGELINA F (LMT,CLT)
Entity Type:Individual
Prefix:MRS
First Name:ANGELINA
Middle Name:F
Last Name:BREEN
Suffix:
Gender:F
Credentials:LMT,CLT
Other - Prefix:MISS
Other - First Name:ANGELINA
Other - Middle Name:F
Other - Last Name:BURGIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT, CLT
Mailing Address - Street 1:5590 WESTBURY RD
Mailing Address - Street 2:
Mailing Address - City:RED CREEK
Mailing Address - State:NY
Mailing Address - Zip Code:13143-4121
Mailing Address - Country:US
Mailing Address - Phone:315-871-9828
Mailing Address - Fax:
Practice Address - Street 1:1 HOFFMAN ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-2157
Practice Address - Country:US
Practice Address - Phone:315-704-0319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022890-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist