MEDICARE: MS. ANGELA DAWN FORETICH MA

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
1	101YM0800X	Mental Health Counselor	MH10764	FL

General Provider Information

NPI Number	:	1225459415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGELA DAWN FORETICH MA

Provider Business Mailing Address
First Line	:	18205 ATHERSTONE TRL
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34638-8139
Country	:	US
Telephone Number	:	727-947-8481
Fax Number	:

Provider Business Practice Location Address
First Line	:	18205 ATHERSTONE TRL
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34638-8139
Country	:	US
Telephone Number	:	727-947-8481
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2013
Last Update Date	:	06/02/2026

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