Provider Demographics
NPI:1760642078
Name:MCCLEOD, ANGELINA BERNETTA
Entity Type:Individual
Prefix:
First Name:ANGELINA
Middle Name:BERNETTA
Last Name:MCCLEOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-5569
Mailing Address - Country:US
Mailing Address - Phone:408-295-5288
Mailing Address - Fax:408-292-1029
Practice Address - Street 1:210 N 4TH ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-5569
Practice Address - Country:US
Practice Address - Phone:408-295-5288
Practice Address - Fax:408-292-1029
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health