Healthcare Provider Details

I. General information

NPI: 1538882196
Provider Name (Legal Business Name): ANGELA PAVLOVNA KUTSAR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 J ST STE 201
SACRAMENTO CA
95816-5542
US

IV. Provider business mailing address

1860 HOWE AVE STE 455
SACRAMENTO CA
95825-1086
US

V. Phone/Fax

Practice location:
  • Phone: 916-454-2345
  • Fax:
Mailing address:
  • Phone: 916-569-8484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number105238
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number129247
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: