Healthcare Provider Details

I. General information

NPI: 1770103996
Provider Name (Legal Business Name): ANGELINA RADICE LPC, LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 MARKETPLACE BLVD # 1210
HAMILTON NJ
08691-2111
US

IV. Provider business mailing address

550 MARKETPLACE BLVD # 1210
HAMILTON NJ
08691-2111
US

V. Phone/Fax

Practice location:
  • Phone: 609-288-8844
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00525900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: