Provider Demographics
NPI:1174859151
Name:ADGER, ANGELA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:ADGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:ADGER-ANTONIKOWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1 CLARA BARTON DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3401
Mailing Address - Country:US
Mailing Address - Phone:518-262-5401
Mailing Address - Fax:
Practice Address - Street 1:1 CLARA BARTON DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3401
Practice Address - Country:US
Practice Address - Phone:518-262-5401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-26
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018328103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical