Provider Demographics
NPI:1023216504
Name:MUSOLINO, ANGELA GABRIELLE (LP)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:GABRIELLE
Last Name:MUSOLINO
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 POTTER AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3050
Mailing Address - Country:US
Mailing Address - Phone:718-442-4009
Mailing Address - Fax:
Practice Address - Street 1:80 FIFTH AVE
Practice Address - Street 2:SUITE 902
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011
Practice Address - Country:US
Practice Address - Phone:917-620-5068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000278102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst