Provider Demographics
NPI:1235329343
Name:DEMONCADA, ANGELIQUE CHANTEL (PHD, MS, MSCP)
Entity Type:Individual
Prefix:DR
First Name:ANGELIQUE
Middle Name:CHANTEL
Last Name:DEMONCADA
Suffix:
Gender:F
Credentials:PHD, MS, MSCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8611 HOLLY POND PL
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-4941
Mailing Address - Country:US
Mailing Address - Phone:301-295-2457
Mailing Address - Fax:301-295-6720
Practice Address - Street 1:1208 SW HARPER RD
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-7555
Practice Address - Country:US
Practice Address - Phone:240-463-3069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60189001103TC0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program