Provider Demographics
NPI:1043710304
Name:ANGARICA, ANISIA (BEHAVIOR TECHNICIAN)
Entity type:Individual
Prefix:MS
First Name:ANISIA
Middle Name:
Last Name:ANGARICA
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:MS
Other - First Name:ANISIA
Other - Middle Name:
Other - Last Name:ANGARICA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BEHAVIOR TECHNICIAN
Mailing Address - Street 1:47 NW 47TH AVE APT 14
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5253
Mailing Address - Country:US
Mailing Address - Phone:786-955-5510
Mailing Address - Fax:
Practice Address - Street 1:47 NW 47TH AVE APT 14
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5253
Practice Address - Country:US
Practice Address - Phone:786-955-5510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022982800Medicaid