Provider Demographics
NPI:1629376892
Name:AGELOPOULOS, ANGELA ELAINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:ELAINE
Last Name:AGELOPOULOS
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 1:17944 FREMONT AVE N
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-4738
Mailing Address - Country:US
Mailing Address - Phone:206-850-5598
Mailing Address - Fax:
Practice Address - Street 1:727 N 182ND ST STE 202
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-4402
Practice Address - Country:US
Practice Address - Phone:206-850-5598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60535146103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist