Provider Demographics
NPI:1497436232
Name:SERRANO, ANGELYCE ALEXIS
Entity Type:Individual
Prefix:
First Name:ANGELYCE
Middle Name:ALEXIS
Last Name:SERRANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 HARDING RD APT D
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-5412
Mailing Address - Country:US
Mailing Address - Phone:631-357-1948
Mailing Address - Fax:
Practice Address - Street 1:214 HARDING RD APT D
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-5412
Practice Address - Country:US
Practice Address - Phone:631-357-1948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112787104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker