Provider Demographics
NPI:1760063408
Name:LINARES D ANGELO, GEIDY
Entity Type:Individual
Prefix:
First Name:GEIDY
Middle Name:
Last Name:LINARES D ANGELO
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 1:536 SW 47TH ST APT B
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-6679
Mailing Address - Country:US
Mailing Address - Phone:239-747-3996
Mailing Address - Fax:
Practice Address - Street 1:536 SW 47TH ST APT B
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-6679
Practice Address - Country:US
Practice Address - Phone:239-747-3996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-15
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-21-11827103K00000X
FL1-21-53582103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst