Provider Demographics
NPI:1518621044
Name:FOGEL, ANGELA MARIE (RMHCI)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:FOGEL
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 NE 15TH ST APT D
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-3359
Mailing Address - Country:US
Mailing Address - Phone:239-601-0052
Mailing Address - Fax:
Practice Address - Street 1:2101 NW CORPORATE BLVD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7306
Practice Address - Country:US
Practice Address - Phone:954-860-3742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-31
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH21373101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health