Provider Demographics
NPI:1215193339
Name:GARRISON, ANGELA MAROTTA (PHD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MAROTTA
Last Name:GARRISON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 THIRD STREET RM. 1120 PSYC
Mailing Address - Street 2:PURDUE UNIVERSITY CAPS
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47907-2081
Mailing Address - Country:US
Mailing Address - Phone:765-494-6995
Mailing Address - Fax:765-494-6995
Practice Address - Street 1:703 THIRD STREET RM. 1120 PSYC
Practice Address - Street 2:PURDUE UNIVERSITY CAPS
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47907-2081
Practice Address - Country:US
Practice Address - Phone:765-494-6995
Practice Address - Fax:765-494-6995
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042857A103TC1900X
103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling