Healthcare Provider Details

I. General information

NPI: 1295859759
Provider Name (Legal Business Name): ANGELA M HUTTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S SANTA CRUZ AVE STE 200
LOS GATOS CA
95030
US

IV. Provider business mailing address

423 DELL AVE
MOUNTAIN VIEW CA
94043-2711
US

V. Phone/Fax

Practice location:
  • Phone: 415-763-7919
  • Fax:
Mailing address:
  • Phone: 720-939-7183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number992531
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801089569
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number27188
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: