Provider Demographics
NPI:1760434849
Name:REAM, ANGELA JEANNE (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:JEANNE
Last Name:REAM
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 1:803 N FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-7323
Mailing Address - Country:US
Mailing Address - Phone:321-637-7730
Mailing Address - Fax:
Practice Address - Street 1:1751 SARNO RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-4909
Practice Address - Country:US
Practice Address - Phone:321-775-1517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 9711101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health