Healthcare Provider Details

I. General information

NPI: 1558840892
Provider Name (Legal Business Name): ANGELA MARCELLINA AURELIEN MSC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2212 MANNING ST
BRONX NY
10462-5002
US

IV. Provider business mailing address

2212 MANNING ST
BRONX NY
10462-5002
US

V. Phone/Fax

Practice location:
  • Phone: 917-568-4802
  • Fax:
Mailing address:
  • Phone: 917-568-4802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: