Provider Demographics
NPI:1871074906
Name:HEALY, ANGELIQUE EDEN
Entity type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:EDEN
Last Name:HEALY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4518 3RD AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-1018
Mailing Address - Country:US
Mailing Address - Phone:813-324-5730
Mailing Address - Fax:727-499-5880
Practice Address - Street 1:4518 3RD AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-1018
Practice Address - Country:US
Practice Address - Phone:813-324-5730
Practice Address - Fax:727-499-5880
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst