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General NPI Number Information
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NPI Number | 1063819118
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Entity Type | Organization
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Legal Business Name | ANGELA VANG, PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 12/04/2014
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Last Update Date | 12/04/2014
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Provider Practice Location Address
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Address Line | 402A HIGHLAND AVE RM F
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City | SOMERVILLE
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State | MA
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Zip | 02144-2511
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Country | US
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Telephone | 857-321-3400
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Fax |
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Provider Business Mailing Address
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Address Line | 11 PARK STREET CT
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City | MEDFORD
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State | MA
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Zip | 02155-3902
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Country | US
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Telephone | 857-321-3400
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MISS ANGELA VANG
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Credential | LICSW
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Telephone | 857-321-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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