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General NPI Number Information
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NPI Number | 1487095550
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Entity Type | Individual
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Provider Name | ANGELIQUE MELENDEZ-BLANCH PSYD
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Gender | Female
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Dates
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Enumeration Date | 07/17/2013
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Last Update Date | 12/04/2020
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Provider Practice Location Address
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Address Line | 1454 MADISON AVE W
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City | IMMOKALEE
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State | FL
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Zip | 34142-2200
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Country | US
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Telephone | 239-658-3720
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Fax | 239-596-1661
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Provider Business Mailing Address
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Address Line | 1454 MADISON AVE W
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City | IMMOKALEE
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State | FL
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Zip | 34142-2200
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Country | US
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Telephone | 239-658-3720
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Fax | 239-596-1661
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2591
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY9517
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License Number State | FL
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