Provider Demographics
NPI:1659464634
Name:CAREDO, ANGELO R (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:R
Last Name:CAREDO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38-11 CORPORAL STONE STREET
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2140
Mailing Address - Country:US
Mailing Address - Phone:718-428-1742
Mailing Address - Fax:718-428-1742
Practice Address - Street 1:38-11 CORPORAL STONE STREET
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2140
Practice Address - Country:US
Practice Address - Phone:718-428-1742
Practice Address - Fax:718-428-1742
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7219103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05241Medicare ID - Type Unspecified