Provider Demographics
NPI:1215238274
Name:ANGILELLA DARTLEY, MARYBETH (PHD)
Entity type:Individual
Prefix:DR
First Name:MARYBETH
Middle Name:
Last Name:ANGILELLA DARTLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARYBETH
Other - Middle Name:
Other - Last Name:ANGILELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:32 GRAMERCY PARK S
Mailing Address - Street 2:10D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-1707
Mailing Address - Country:US
Mailing Address - Phone:212-420-9691
Mailing Address - Fax:
Practice Address - Street 1:30 E 20TH ST STE 5RW
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1310
Practice Address - Country:US
Practice Address - Phone:917-696-7080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WATE61249834103TC1900X
NY018009-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling