Provider Demographics
NPI:1457846008
Name:ANGELA M. CAIAZZA, PC
Entity Type:Organization
Organization Name:ANGELA M. CAIAZZA, PC
Other - Org Name:FULFILLMENT FAMILY THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, LMFT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CAIAZZA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:503-516-8266
Mailing Address - Street 1:123 E POWELL BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7620
Mailing Address - Country:US
Mailing Address - Phone:503-516-8266
Mailing Address - Fax:
Practice Address - Street 1:123 E POWELL BLVD STE 303
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7620
Practice Address - Country:US
Practice Address - Phone:503-516-8266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0828106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty