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General NPI Number Information
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NPI Number | 1538248174
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Entity Type | Individual
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Provider Name | ANGELA M. MICKELIS PHD
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Gender | Female
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 257 CASTRO ST STE 218
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94041-1287
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Country | US
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Telephone | 650-238-4959
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Fax |
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Provider Business Mailing Address
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Address Line | 23541 SKY VIEW TER
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City | LOS GATOS
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State | CA
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Zip | 95033-9210
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Country | US
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Telephone | 650-238-4959
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Fax | 408-353-6053
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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