Provider Demographics
NPI:1477735082
Name:CANESTRARO, ANGELA CLEVE (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:CLEVE
Last Name:CANESTRARO
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 STANWELL DR.
Mailing Address - Street 2:SUITE 104A
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-4902
Mailing Address - Country:US
Mailing Address - Phone:925-471-1380
Mailing Address - Fax:925-322-5877
Practice Address - Street 1:2600 STANWELL DR STE 104A
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520
Practice Address - Country:US
Practice Address - Phone:925-471-1380
Practice Address - Fax:925-322-5877
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE101Y00000X
101Y00000X
CA104500106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor