Provider Demographics
NPI:1346228608
Name:DANGELO, ROBERT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:DANGELO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4618 WOODSIDE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77023-1222
Mailing Address - Country:US
Mailing Address - Phone:713-898-0661
Mailing Address - Fax:206-984-9632
Practice Address - Street 1:3303 MAIN ST
Practice Address - Street 2:SUITE 304
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-9322
Practice Address - Country:US
Practice Address - Phone:713-898-0661
Practice Address - Fax:206-984-9632
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31259103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2164946OtherCOMPSYCH
TX10012380OtherAMERIGROUP
TX00083POtherBCBS
TX00083PMedicare ID - Type Unspecified