Provider Demographics
NPI:1497196596
Name:GRIPP, ANGELINA TERESA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANGELINA
Middle Name:TERESA
Last Name:GRIPP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2488 NEWPORT BLVD STE A1
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-5196
Mailing Address - Country:US
Mailing Address - Phone:949-339-9981
Mailing Address - Fax:
Practice Address - Street 1:2488 NEWPORT BLVD STE A1
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-5196
Practice Address - Country:US
Practice Address - Phone:949-339-9981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
CALCSW807611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner