Provider Demographics
NPI:1376106450
Name:ANGELO, NICHOLAS ANTHONY (LMFT 144221)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ANTHONY
Last Name:ANGELO
Suffix:
Gender:M
Credentials:LMFT 144221
Other - Prefix:
Other - First Name:NICHOLAS
Other - Middle Name:
Other - Last Name:ANGELO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT 144221
Mailing Address - Street 1:2033 SAN ELIJO AVE # 302
Mailing Address - Street 2:
Mailing Address - City:CARDIFF
Mailing Address - State:CA
Mailing Address - Zip Code:92007-1726
Mailing Address - Country:US
Mailing Address - Phone:442-354-4695
Mailing Address - Fax:
Practice Address - Street 1:315 N CLEMENTINE ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-2806
Practice Address - Country:US
Practice Address - Phone:442-354-4695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA144221101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty