Provider Demographics
NPI:1881747608
Name:HARAKAS, ANGELICA S (APRN)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:S
Last Name:HARAKAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 POMEROY TER
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3304
Mailing Address - Country:US
Mailing Address - Phone:413-582-7076
Mailing Address - Fax:
Practice Address - Street 1:1727 NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-1919
Practice Address - Country:US
Practice Address - Phone:413-532-1926
Practice Address - Fax:413-532-1928
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA215277364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANS0764Medicare ID - Type Unspecified