Healthcare Provider Details

I. General information

NPI: 1275446395
Provider Name (Legal Business Name): SAMANTHA ANGULO LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WESTON RD
WESTON FL
33326-1987
US

IV. Provider business mailing address

1200 WESTON RD 3RD FLOOR
WESTON FL
33326-1987
US

V. Phone/Fax

Practice location:
  • Phone: 954-769-1285
  • Fax:
Mailing address:
  • Phone: 954-769-1285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH28621
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: