Angelique Melendez-Blanch, PSYD
Individual provider Active NPI Psychologist · Immokalee, FL
NPI 1487095550 · NPPES record last updated Dec 4, 2020
Key facts
- NPI
- 1487095550
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- PY9517 (FL)
- Practice address
- 1454 Madison Ave W
Immokalee, FL 34142-2200 - Phone
- (239) 658-3720
- Fax
- (239) 596-1661
- NPI assigned
- Jul 17, 2013
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Psychologist | 103T00000X | 2591 | OR | |
| Psychologist | 103T00000X | PY9517 | FL | Yes |
Addresses
Primary practice location
1454 Madison Ave W
Immokalee, FL 34142-2200
Mailing address
1454 Madison Ave W
Immokalee, FL 34142-2200
Phone (239) 658-3720
Other providers in Immokalee, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 4, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.