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General NPI Number Information
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NPI Number | 1699429464
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Entity Type | Individual
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Provider Name | ANGELICA MARIA THORNE
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Gender | Female
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Dates
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Enumeration Date | 02/09/2022
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Last Update Date | 02/09/2022
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Provider Practice Location Address
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Address Line | 2639 W OXFORD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19121-2843
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Country | US
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Telephone | 267-532-4494
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Fax |
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Provider Business Mailing Address
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Address Line | 23 RED MAPLE RD
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City | SMYRNA
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State | DE
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Zip | 19977-5224
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Country | US
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Telephone | 302-252-5716
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Fax |
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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 | SW138607
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License Number State | PA
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