Provider Demographics
NPI:1932959145
Name:ABBOTT KEIPER, ANGELA CRISTINA
Entity Type:Individual
Prefix:MRS
First Name:ANGELA CRISTINA
Middle Name:
Last Name:ABBOTT KEIPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7667 N WICKHAM RD APT 717
Mailing Address - Street 2:
Mailing Address - City:VIERA
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7934
Mailing Address - Country:US
Mailing Address - Phone:321-462-9345
Mailing Address - Fax:
Practice Address - Street 1:3251 ENGINEERING ST
Practice Address - Street 2:
Practice Address - City:MELBORNE
Practice Address - State:FL
Practice Address - Zip Code:32901
Practice Address - Country:US
Practice Address - Phone:321-674-8106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-309215106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician