Provider Demographics
NPI:1770064115
Name:LABOY, MARANGELI (BA)
Entity type:Individual
Prefix:
First Name:MARANGELI
Middle Name:
Last Name:LABOY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 VISTA HAVEN CIR APT 205
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-3526
Mailing Address - Country:US
Mailing Address - Phone:787-306-5498
Mailing Address - Fax:
Practice Address - Street 1:1030 VISTA HAVEN CIR APT 205
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-3526
Practice Address - Country:US
Practice Address - Phone:787-306-5498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR197941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02121985Medicaid