Provider Demographics
NPI:1851614390
Name:D'ANGLADA, DIANA ISABEL (MA)
Entity type:Individual
Prefix:MISS
First Name:DIANA
Middle Name:ISABEL
Last Name:D'ANGLADA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1954 SE AVON PARK DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7797
Mailing Address - Country:US
Mailing Address - Phone:772-333-0897
Mailing Address - Fax:
Practice Address - Street 1:2550 SE WALTON RD FL 34952
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7168
Practice Address - Country:US
Practice Address - Phone:772-335-0400
Practice Address - Fax:772-335-5855
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3529101YM0800X, 103TS0200X
FLMH20394101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool