Provider Demographics
NPI:1841384500
Name:ITO, ANGIE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:ITO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 MOSS CT
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-1978
Mailing Address - Country:US
Mailing Address - Phone:707-322-1651
Mailing Address - Fax:
Practice Address - Street 1:1434 THIRD ST
Practice Address - Street 2:SUITE 3D
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-2891
Practice Address - Country:US
Practice Address - Phone:707-322-1651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 209511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical