Provider Demographics
NPI:1518790906
Name:FLORES, ANGELICA KASSANDRA (MHC- LP)
Entity type:Individual
Prefix:MS
First Name:ANGELICA
Middle Name:KASSANDRA
Last Name:FLORES
Suffix:
Gender:F
Credentials:MHC- LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1971 WEBSTER AVENUE
Mailing Address - Street 2:APT. 5J
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457
Mailing Address - Country:US
Mailing Address - Phone:646-538-6222
Mailing Address - Fax:
Practice Address - Street 1:5676 RIVERDALE AVE STE 202
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-2100
Practice Address - Country:US
Practice Address - Phone:718-796-5300
Practice Address - Fax:718-548-1161
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP123910101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health