Provider Demographics
NPI:1245735455
Name:MINERVA, ANGEL KATELYN
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:KATELYN
Last Name:MINERVA
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 1:16470 GLASSY LOCH LOOP
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-6608
Mailing Address - Country:US
Mailing Address - Phone:321-289-2551
Mailing Address - Fax:
Practice Address - Street 1:2105 HARTWOOD MARSH RD STE 7
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5390
Practice Address - Country:US
Practice Address - Phone:407-720-5067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-17-42286106S00000X
FL1-21-53880103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician