| Doctor Name: | MS. DWYLA J ANGELOS |
| NPI Number: | 1023171998 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, LMHC |
| License Number: | LMHC 603 |
| Business Practice Address: | 1613 Blue Hill Ave. Priority Professional Care Suite 302 Mattapan, MA - 02126 |
| Business Phone Number: | 8575984774 |
| Business Fax Number: | 8575984816 |
| Mailing Address: | 1613 Blue Hill Ave., Priority Professional Care Suite 302 MATTAPAN |
| State: | MA |
| Postal Code: | 02126 |
| Phone Number: | 8575984774 |
| Fax Number: | 8575984816 |
| NPI Enumeration Date: | 12/19/2006 |
| NPI Last Update Date: | 09/04/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LMHC 603 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |