Provider Demographics
NPI:1326469461
Name:ANGELONE, ALISA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALISA
Middle Name:
Last Name:ANGELONE
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 1:715 N CENTRAL AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1286
Mailing Address - Country:US
Mailing Address - Phone:818-699-2110
Mailing Address - Fax:
Practice Address - Street 1:715 N CENTRAL AVE STE 102
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1286
Practice Address - Country:US
Practice Address - Phone:818-699-2110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-16
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31539103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical