Provider Demographics
NPI:1629213897
Name:CHANTER, ANGELA MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MARIE
Last Name:CHANTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1895 E ROSEVILLE PKWY
Mailing Address - Street 2:SUITE 190
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-7976
Mailing Address - Country:US
Mailing Address - Phone:916-439-5638
Mailing Address - Fax:916-774-6018
Practice Address - Street 1:1895 E ROSEVILLE PKWY
Practice Address - Street 2:SUITE 190
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-7976
Practice Address - Country:US
Practice Address - Phone:916-439-5638
Practice Address - Fax:916-774-6018
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20014103T00000X, 103TC0700X
103TA0400X, 103TB0200X, 103TC2200X, 103TF0000X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy