Provider Demographics
NPI:1497015697
Name:SOWA, ANGELA A (PSYD MFT)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:A
Last Name:SOWA
Suffix:
Gender:F
Credentials:PSYD MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 FREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-5698
Mailing Address - Country:US
Mailing Address - Phone:650-917-9650
Mailing Address - Fax:650-917-1580
Practice Address - Street 1:851 FREMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-5698
Practice Address - Country:US
Practice Address - Phone:650-917-9650
Practice Address - Fax:650-917-1580
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 28739101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health