Provider Demographics
NPI:1932664141
Name:DEVLIN, ANGELIQUE BERNADETTE (LMT)
Entity Type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:BERNADETTE
Last Name:DEVLIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 MAIN ST STE 121
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-2732
Mailing Address - Country:US
Mailing Address - Phone:914-227-5027
Mailing Address - Fax:
Practice Address - Street 1:60 W CENTER ST # 1
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-3250
Practice Address - Country:US
Practice Address - Phone:845-288-3390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027697-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist