Healthcare Provider Details

I. General information

NPI: 1043003569
Provider Name (Legal Business Name): ANGELIQUE SEVER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6310 WAVES END PL
APOLLO BEACH FL
33572-1738
US

IV. Provider business mailing address

6310 WAVES END PL
APOLLO BEACH FL
33572-1738
US

V. Phone/Fax

Practice location:
  • Phone: 617-777-5811
  • Fax:
Mailing address:
  • Phone: 617-777-5811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number25807
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: