Individual
ANGEL LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
928 BROADWAY, NEW YORK, NY 10010-6008
(833) 775-6252
Mailing address
15 OREGON ST, MAPLEWOOD, NJ 07040-3514
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
37AC00742700
NJ
Other
Enumeration date
09/25/2023
Last updated
09/25/2023
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