Provider Demographics
NPI:1588807010
Name:MINETT, ANGELA (BCABA)
Entity Type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:
Last Name:MINETT
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E NEW YORK AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-5568
Mailing Address - Country:US
Mailing Address - Phone:386-738-5543
Mailing Address - Fax:386-738-9821
Practice Address - Street 1:120 E NEW YORK AVE
Practice Address - Street 2:SUITE B
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-5568
Practice Address - Country:US
Practice Address - Phone:386-738-5543
Practice Address - Fax:386-738-9821
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst