Provider Demographics
NPI:1134101611
Name:ANGOTTA, CHAD JOSEPH (MA, MFT)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:JOSEPH
Last Name:ANGOTTA
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17452 IRVINE BLVD
Mailing Address - Street 2:SUITE #214
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3031
Mailing Address - Country:US
Mailing Address - Phone:714-731-6111
Mailing Address - Fax:
Practice Address - Street 1:17452 IRVINE BLVD
Practice Address - Street 2:SUITE #214
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3031
Practice Address - Country:US
Practice Address - Phone:714-731-6111
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC18168106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC18168OtherLICENSE NUMBER