Provider Demographics
NPI:1659994168
Name:COPPOLA, ANGELICA NOEL (MS)
Entity Type:Individual
Prefix:MISS
First Name:ANGELICA
Middle Name:NOEL
Last Name:COPPOLA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10720 LAKEWOOD BLVD APT 339
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-3598
Mailing Address - Country:US
Mailing Address - Phone:203-444-0965
Mailing Address - Fax:
Practice Address - Street 1:3424 MOTOR AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-4710
Practice Address - Country:US
Practice Address - Phone:424-672-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-18-69156106S00000X
CA1-21-54237103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician