Provider Demographics
NPI:1841339322
Name:ANGELO, LINDA B (MS)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:B
Last Name:ANGELO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 W 2ND ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-9002
Mailing Address - Country:US
Mailing Address - Phone:859-255-4864
Mailing Address - Fax:859-255-5385
Practice Address - Street 1:535 W 2ND ST
Practice Address - Street 2:SUITE 207
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-9002
Practice Address - Country:US
Practice Address - Phone:859-255-4864
Practice Address - Fax:859-255-5385
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY001103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY89000012Medicaid
KYCP00133Medicare ID - Type Unspecified