Provider Demographics
NPI:1063877728
Name:BURLEY, ANGEL
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:BURLEY
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:PO BOX 389
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:MA
Mailing Address - Zip Code:02322-0389
Mailing Address - Country:US
Mailing Address - Phone:617-750-1379
Mailing Address - Fax:
Practice Address - Street 1:15 NICHOLS AVE
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:MA
Practice Address - Zip Code:02322-1709
Practice Address - Country:US
Practice Address - Phone:617-750-1379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor