Basic Information
Provider Information
NPI: 1851535579
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ANGLERO
FirstName: ANTONIO
MiddleName:  
NamePrefix: DR.
NameSuffix: JR.
Credential: PSY.D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 700 8TH AVE W STE 101
Address2:  
City: PALMETTO
State: FL
PostalCode: 342214737
CountryCode: US
TelephoneNumber: 9417764000
FaxNumber: 9418454963
Practice Location
Address1: 725 N 12TH AVE BLDG B
Address2:  
City: ARCADIA
State: FL
PostalCode: 34266
CountryCode: US
TelephoneNumber: 8634941242
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/24/2009
LastUpdateDate: 07/09/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103T00000XPY8316FLY Behavioral Health & Social Service ProvidersPsychologist 

No ID Information.


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