Provider Demographics
NPI:1013256882
Name:BRIONES, ANGELICA (CCC-SLP TSSLD-BE)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:BRIONES
Suffix:
Gender:F
Credentials:CCC-SLP TSSLD-BE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8012 85TH RD
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-1114
Mailing Address - Country:US
Mailing Address - Phone:929-777-0153
Mailing Address - Fax:
Practice Address - Street 1:8528 BRITTON AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1434
Practice Address - Country:US
Practice Address - Phone:718-898-2230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024489-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist