Provider Demographics
NPI:1871276139
Name:OLIVEIRA, ANGELICA DE SOUSA
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:DE SOUSA
Last Name:OLIVEIRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 WEST ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-2404
Mailing Address - Country:US
Mailing Address - Phone:617-462-5580
Mailing Address - Fax:
Practice Address - Street 1:90 WEST ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-2404
Practice Address - Country:US
Practice Address - Phone:617-462-5580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician