Provider Demographics
NPI:1780751719
Name:ANGELOTTA, JOHN W (PHD, PCC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:ANGELOTTA
Suffix:
Gender:M
Credentials:PHD, PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29325 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4600
Mailing Address - Country:US
Mailing Address - Phone:216-292-9166
Mailing Address - Fax:216-292-9166
Practice Address - Street 1:29325 CHAGRIN BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4600
Practice Address - Country:US
Practice Address - Phone:216-292-9166
Practice Address - Fax:216-292-9166
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0000226101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional