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General NPI Number Information
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NPI Number | 1801678685
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Entity Type | Individual
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Provider Name | ANGELA MARIE FIDAZZO PHD
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Gender | Female
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Dates
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Enumeration Date | 10/17/2023
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 1386 OLD FREEPORT RD STE 1AF
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City | PITTSBURGH
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State | PA
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Zip | 15238-3115
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Country | US
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Telephone | 412-406-7052
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Fax |
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Provider Business Mailing Address
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Address Line | 6 LORRIE DR
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City | IRWIN
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State | PA
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Zip | 15642-9419
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Country | US
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Telephone | 724-757-8348
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Fax |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS020006
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License Number State | PA
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