Provider Demographics
NPI:1861019911
Name:ROBLES, ANGELIQUE JULIA (MA)
Entity type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:JULIA
Last Name:ROBLES
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:PO BOX 23494
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85063-3494
Mailing Address - Country:US
Mailing Address - Phone:623-330-9550
Mailing Address - Fax:
Practice Address - Street 1:20470 N LAKE PLEASANT RD STE 107
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-9708
Practice Address - Country:US
Practice Address - Phone:623-248-3324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1-23-68839103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst