Provider Demographics
NPI:1508369679
Name:BARRY, ANGELA (LMHC, MS)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:BARRY
Suffix:
Gender:F
Credentials:LMHC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3680 AVALON PARK EAST BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-9372
Mailing Address - Country:US
Mailing Address - Phone:407-801-7989
Mailing Address - Fax:
Practice Address - Street 1:3680 AVALON PARK EAST BLVD, STE 301
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828
Practice Address - Country:US
Practice Address - Phone:321-351-4925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60746043101YM0800X
FLMH19982101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health