Provider Demographics
NPI:1508038779
Name:WILBUR, ANGELA FORSBERG (PSYD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:FORSBERG
Last Name:WILBUR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 UNION STREET
Mailing Address - Street 2:BEHAVIORAL HEALTH DEPT
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901
Mailing Address - Country:US
Mailing Address - Phone:781-586-6551
Mailing Address - Fax:781-598-8137
Practice Address - Street 1:269 UNION STREET
Practice Address - Street 2:BEHAVIORAL HEALTH DEPT
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901
Practice Address - Country:US
Practice Address - Phone:781-586-6551
Practice Address - Fax:781-598-8137
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8836103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist