Provider Demographics
NPI:1063819118
Name:ANGELA VANG, PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:ANGELA VANG, PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANG
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:857-321-3400
Mailing Address - Street 1:11 PARK STREET CT
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-3902
Mailing Address - Country:US
Mailing Address - Phone:857-321-3400
Mailing Address - Fax:
Practice Address - Street 1:402A HIGHLAND AVE RM F
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2511
Practice Address - Country:US
Practice Address - Phone:857-321-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty