Provider Demographics
NPI:1245790880
Name:ANGIERI, JONATHAN DAVID I
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:DAVID
Last Name:ANGIERI
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-5543
Mailing Address - Country:US
Mailing Address - Phone:918-899-0390
Mailing Address - Fax:
Practice Address - Street 1:1100 S 3RD ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-5543
Practice Address - Country:US
Practice Address - Phone:918-899-0390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)