Provider Demographics
NPI:1053645630
Name:DEVITA, ANGELA (PHD, LMFT, ATR)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:DEVITA
Suffix:
Gender:F
Credentials:PHD, LMFT, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 E SANTA CLARA ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-2964
Mailing Address - Country:US
Mailing Address - Phone:805-304-5705
Mailing Address - Fax:
Practice Address - Street 1:790 E SANTA CLARA ST
Practice Address - Street 2:SUITE 103
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-2964
Practice Address - Country:US
Practice Address - Phone:805-304-5705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC47377106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist