Provider Demographics
NPI:1104662469
Name:ADEBAYO, ANGELICA
Entity type:Individual
Prefix:MRS
First Name:ANGELICA
Middle Name:
Last Name:ADEBAYO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELICA
Other - Middle Name:
Other - Last Name:BERTKO-TOWNSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1650 BALLINGER ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15210-3448
Mailing Address - Country:US
Mailing Address - Phone:724-630-7162
Mailing Address - Fax:
Practice Address - Street 1:1650 BALLINGER ST APT 2A
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15210-3448
Practice Address - Country:US
Practice Address - Phone:724-630-7162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-06
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH007143101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health