Healthcare Provider Details

I. General information

NPI: 1124889274
Provider Name (Legal Business Name): ANGELINA ROSEMARY NADER AMFT, ATR-P
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 SANTA CLARA AVE STE 220
OAKLAND CA
94610-1375
US

IV. Provider business mailing address

111 LIBERTY ST
SANTA CRUZ CA
95060-6512
US

V. Phone/Fax

Practice location:
  • Phone: 510-675-7070
  • Fax:
Mailing address:
  • Phone: 949-478-1677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102X00000X
TaxonomyPoetry Therapist
License NumberATR-P24-029
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberATR-P24-029
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT140321
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: