Provider Demographics
NPI:1700166527
Name:D'ANGELO, ARTY
Entity Type:Individual
Prefix:
First Name:ARTY
Middle Name:
Last Name:D'ANGELO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 REDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:N PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02911-3427
Mailing Address - Country:US
Mailing Address - Phone:310-855-4302
Mailing Address - Fax:
Practice Address - Street 1:1021 N CRESCENT HEIGHTS BLVD APT 203
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-6050
Practice Address - Country:US
Practice Address - Phone:310-855-4302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1150711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical