Healthcare Provider Details

I. General information

NPI: 1962849729
Provider Name (Legal Business Name): ANGELICA MONTEVERDE PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 WINGATE DR
WILLIAMSBURG VA
23185-2995
US

IV. Provider business mailing address

103 WINGATE DR
WILLIAMSBURG VA
23185-2995
US

V. Phone/Fax

Practice location:
  • Phone: 973-699-6308
  • Fax:
Mailing address:
  • Phone: 973-699-6308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY10308
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0810007574
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: