Active NPI
Angena Mombrun, LPC
- Professional Counselor
- Philadelphia, PA
National Provider Identifier
1821696535
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- PC012626
- Practice address
- 100 N 18TH St
Philadelphia, PA 19103-2707 - Phone
- (484) 450-6598
- NPI assigned
- Oct 14, 2020
- Last updated
- Jul 12, 2021
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | PC012626 | PA | Primary |
Addresses
Primary practice location
100 N 18TH St
Philadelphia, PA 19103-2707
Mailing address
3700 Conshohocken Ave
Philadelphia, PA 19131-2823
Phone (267) 235-8449
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 |
|---|---|---|---|
| PC012626 | PA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1602633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626048000000",
"number": "1821696535",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3700 CONSHOHOCKEN AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191312823",
"telephone_number": "267-235-8449"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 N 18TH ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191032707",
"telephone_number": "484-450-6598"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOMBRUN",
"first_name": "ANGENA",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-10-14",
"last_updated": "2021-07-12",
"certification_date": "2021-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "PA",
"license": "PC012626",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.