Provider Demographics
NPI:1558126078
Name:NELSON, ANGELA Y
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:Y
Last Name:NELSON
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 1:1905 BLOOMINGDALE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-3002
Mailing Address - Country:US
Mailing Address - Phone:667-910-4615
Mailing Address - Fax:
Practice Address - Street 1:1905 BLOOMINGDALE RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-3002
Practice Address - Country:US
Practice Address - Phone:667-910-4615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health