Provider Demographics
NPI:1770799330
Name:WINSLOW, ANGELA GEHEGAN (MFT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:GEHEGAN
Last Name:WINSLOW
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4272 ALTAMIRANO WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1002
Mailing Address - Country:US
Mailing Address - Phone:619-291-8040
Mailing Address - Fax:
Practice Address - Street 1:5030 CAMINO DE LA SIESTA
Practice Address - Street 2:#106
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3116
Practice Address - Country:US
Practice Address - Phone:619-574-8954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41963106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist