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General NPI Number Information
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NPI Number | 1851614390
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Entity Type | Individual
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Provider Name | DIANA ISABEL D'ANGLADA MA
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Gender | Female
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Dates
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Enumeration Date | 03/11/2010
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 2550 SE WALTON RD FL 34952
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-7168
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Country | US
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Telephone | 772-335-0400
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Fax | 772-335-5855
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Provider Business Mailing Address
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Address Line | 1954 SE AVON PARK DR
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-7797
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Country | US
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Telephone | 772-333-0897
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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 | 3529
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 3529
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH20394
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License Number State | FL
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