Provider Demographics
NPI:1801678685
Name:FIDAZZO, ANGELA MARIE (PHD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:FIDAZZO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 LORRIE DR
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-9419
Mailing Address - Country:US
Mailing Address - Phone:724-757-8348
Mailing Address - Fax:
Practice Address - Street 1:1386 OLD FREEPORT RD STE 1AF
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-3115
Practice Address - Country:US
Practice Address - Phone:412-406-7052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-17
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS020006103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist