Provider Demographics
NPI:1154447225
Name:ANGILLETTA, TRICIA M (PSYD, LPC, ATR-BC)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:M
Last Name:ANGILLETTA
Suffix:
Gender:F
Credentials:PSYD, LPC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HILLCREST AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-1315
Mailing Address - Country:US
Mailing Address - Phone:856-858-3402
Mailing Address - Fax:856-547-9220
Practice Address - Street 1:561 FAIRTHORNE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-2412
Practice Address - Country:US
Practice Address - Phone:215-487-4196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008931101YP2500X
NJ37PC00335900101YP2500X
NJ221700000X
PAPS018106103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist