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NPI Code Detail

MEDICARE: ANGELA J BURLEIGH

MEDICARE: ANGELA J BURLEIGH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1154935062
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANGELA J BURLEIGH
Provider Business Mailing Address
First Line : 5364 E KALEY ST
Second Line :
City : ORLANDO
State : FL
Zip : 32812-8864
Country : US
Telephone Number : 239-297-3687
Fax Number :
Provider Business Practice Location Address
First Line : 206 W SYBELIA AVE
Second Line :
City : MAITLAND
State : FL
Zip : 32751-4739
Country : US
Telephone Number : 843-779-5591
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MRS. ANGELA BURLEIGH
Credential : LMHC
Telephone Number : 843-779-5591
Provider Enumeration Date : 09/08/2020
Last Update Date : 09/08/2020

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