Provider Demographics
NPI:1336427947
Name:MANN, ANGELA R (PHD,BCBA)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:R
Last Name:MANN
Suffix:
Gender:F
Credentials:PHD,BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 EDGEWOOD AVE S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-5369
Mailing Address - Country:US
Mailing Address - Phone:904-513-0154
Mailing Address - Fax:
Practice Address - Street 1:1065 NELSON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-6015
Practice Address - Country:US
Practice Address - Phone:813-270-9210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-11-8487103K00000X
FLPY9231103TC2200X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst