Provider Demographics
NPI:1194291849
Name:CANQUE-KAPLAN, ANGELA ORTIZ (LMHC)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:ORTIZ
Last Name:CANQUE-KAPLAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11213 CEDAR HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-8703
Mailing Address - Country:US
Mailing Address - Phone:941-661-1211
Mailing Address - Fax:
Practice Address - Street 1:300 E MADISON ST STE 201
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-4813
Practice Address - Country:US
Practice Address - Phone:813-609-6946
Practice Address - Fax:813-609-6947
Is Sole Proprietor?:No
Enumeration Date:2018-10-21
Last Update Date:2018-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16391101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health