Provider Demographics
NPI:1124485693
Name:LUGO, ANGELA (MS, ED)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:LUGO
Suffix:
Gender:F
Credentials:MS, ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 EVERETT RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL HALL
Mailing Address - State:NY
Mailing Address - Zip Code:10916-2111
Mailing Address - Country:US
Mailing Address - Phone:917-723-9168
Mailing Address - Fax:
Practice Address - Street 1:21 EVERETT RD
Practice Address - Street 2:
Practice Address - City:CAMPBELL HALL
Practice Address - State:NY
Practice Address - Zip Code:10916-2111
Practice Address - Country:US
Practice Address - Phone:917-723-9168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2020-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY952628151103K00000X
NY952909151103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst