| Angel Clinical Therapy Of Broward Llc | |
|
4961 Sw 148th Ave Davie FL 33330-2419 | |
| (786) 663-2822 | |
| Not Available |
| Full Name | Angel Clinical Therapy Of Broward Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4961 Sw 148th Ave, Davie, Florida |
| Authorized Official Name and Position | Alexandra Codecido (OWNER) |
| Authorized Official Contact | 7866632822 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Angel Clinical Therapy Of Broward Llc 4961 Sw 148th Ave Davie FL 33330-2419 Ph: (786) 663-2822 | Angel Clinical Therapy Of Broward Llc 4961 Sw 148th Ave Davie FL 33330-2419 Ph: (786) 663-2822 |
| NPI Number | 1588448625 |
|---|---|
| Provider Enumeration Date | 08/21/2023 |
| Last Update Date | 08/21/2023 |
| Certification Date | 08/21/2023 |
| Medicare PECOS PAC ID | 3375997638 |
|---|---|
| Medicare Enrollment ID | O20230921000065 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588448625 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Hernan Pabon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669683751 PECOS PAC ID: 2668556507 Enrollment ID: I20080301000013 |
| Provider Name | Angela Maria Hansen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235685181 PECOS PAC ID: 6002212255 Enrollment ID: I20210914000281 |
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