Provider Demographics
NPI:1659522183
Name:FENTON, ANGELA (MA, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:FENTON
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HIGHLAND ST
Mailing Address - Street 2:SUITE 222
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3881
Mailing Address - Country:US
Mailing Address - Phone:617-313-1440
Mailing Address - Fax:617-696-6655
Practice Address - Street 1:100 HIGHLAND ST
Practice Address - Street 2:SUITE 222
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-3881
Practice Address - Country:US
Practice Address - Phone:617-696-0660
Practice Address - Fax:617-696-6655
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6581101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health