Active NPI
Angela J Medina-Lago
- Counseling Psychologist
- Longwood, FL
National Provider Identifier
1073888988
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- Practice address
- 2290 N Ronald Reagan Blvd Ste 116
Longwood, FL 32750-3534 - Phone
- (407) 962-7953
- NPI assigned
- Mar 12, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | NO | FL | |
| Counseling Psychologist | 103TC1900X | Primary |
Addresses
Primary practice location
2290 N Ronald Reagan Blvd Ste 116
Longwood, FL 32750-3534
Mailing address
2290 N Ronald Reagan Blvd Ste 116
Longwood, FL 32750-3534
Phone (407) 962-7953
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NO | FL | MD | Counseling Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Impower, Inc | Counselor | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1331510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718236800000",
"number": "1073888988",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2290 N RONALD REAGAN BLVD STE 116",
"city": "LONGWOOD",
"state": "FL",
"postal_code": "327503534",
"telephone_number": "407-962-7953"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2290 N RONALD REAGAN BLVD STE 116",
"city": "LONGWOOD",
"state": "FL",
"postal_code": "327503534",
"telephone_number": "407-962-7953"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDINA-LAGO",
"first_name": "ANGELA",
"middle_name": "J",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-03-12",
"last_updated": "2024-06-13",
"certification_date": "2024-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychologist, Counseling",
"state": "FL",
"license": "NO",
"primary": false
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Longwood, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.