Healthcare Provider Details

I. General information

NPI: 1174797500
Provider Name (Legal Business Name): ANGELA M CAIAZZA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 E POWELL BLVD SUITE #303
GRESHAM OR
97030-7624
US

IV. Provider business mailing address

123 E POWELL BLVD SUITE #303
GRESHAM OR
97030-7624
US

V. Phone/Fax

Practice location:
  • Phone: 503-516-8266
  • Fax:
Mailing address:
  • Phone: 503-516-8266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number01132
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT0828
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: