Provider Demographics
NPI:1639879497
Name:ANGELICOMM, LLC
Entity Type:Organization
Organization Name:ANGELICOMM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARA
Authorized Official - Middle Name:B
Authorized Official - Last Name:ANGELICO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP TSSLD
Authorized Official - Phone:914-221-0090
Mailing Address - Street 1:22 PINEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-4713
Mailing Address - Country:US
Mailing Address - Phone:914-221-0090
Mailing Address - Fax:
Practice Address - Street 1:22 PINEBROOK DR
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-4713
Practice Address - Country:US
Practice Address - Phone:914-221-0090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty