Provider Demographics
NPI:1699429464
Name:THORNE, ANGELICA MARIA
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:MARIA
Last Name:THORNE
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 1:23 RED MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-5224
Mailing Address - Country:US
Mailing Address - Phone:302-252-5716
Mailing Address - Fax:
Practice Address - Street 1:2639 W OXFORD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-2843
Practice Address - Country:US
Practice Address - Phone:267-532-4494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW138607101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health