Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 000822 | NY |
N | 103T00000X | Psychologist | 000822 | NY |
Y | 1041C0700X | Clinical Social Worker | 070978 | NY |
NPI | 1003099680 |
---|---|
Provider Name | Angela Rita-Farias |
First Address | Clermont, FL 34714-4935 |
Second Address | Peekskill, NY 10566-1921 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2007 |
Last Update Date | 20/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070978-1 | LCSW (01) | NY |