Provider Demographics
NPI:1962849729
Name:MONTEVERDE, ANGELICA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANGELICA
Middle Name:
Last Name:MONTEVERDE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 FILLY LN
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-1080
Mailing Address - Country:US
Mailing Address - Phone:973-699-6308
Mailing Address - Fax:
Practice Address - Street 1:3121 FILLY LN
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33811-1080
Practice Address - Country:US
Practice Address - Phone:973-699-6308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2020-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLPY10308103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health