Provider Demographics
NPI:1497085856
Name:BRINSON, ANGELA C (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:C
Last Name:BRINSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18425 N.W. 2ND AVENUE 4TH FL
Mailing Address - Street 2:SUITE 402
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4534
Mailing Address - Country:US
Mailing Address - Phone:954-257-7473
Mailing Address - Fax:877-478-5333
Practice Address - Street 1:18425 N.W. 2ND AVENUE 4TH FL
Practice Address - Street 2:SUITE 402
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-4619
Practice Address - Country:US
Practice Address - Phone:954-257-7473
Practice Address - Fax:877-478-5333
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-07
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS914103TC2200X, 103T00000X
FLSS 914103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015913600Medicaid