Provider Demographics
NPI:1497506521
Name:ANGLADE, TATYANA V (LCSW)
Entity Type:Individual
Prefix:
First Name:TATYANA
Middle Name:V
Last Name:ANGLADE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10651 NW 41ST ST
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-2312
Mailing Address - Country:US
Mailing Address - Phone:954-907-5179
Mailing Address - Fax:
Practice Address - Street 1:10651 NW 41ST ST
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-2312
Practice Address - Country:US
Practice Address - Phone:954-907-5179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW194311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty