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General NPI Number Information
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NPI Number | 1871065078
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Entity Type | Individual
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Provider Name | KATELYN ANGELO LMFT
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Gender | Female
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Dates
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Enumeration Date | 12/28/2018
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Last Update Date | 08/10/2020
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Provider Practice Location Address
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Address Line | 120 W PARK AVE STE 312
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City | LONG BEACH
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State | NY
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Zip | 11561-3301
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Country | US
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Telephone | 516-672-3830
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Fax | 516-706-0421
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Provider Business Mailing Address
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Address Line | 2375 LOFT AVE
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City | BALDWIN
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State | NY
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Zip | 11510-3426
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Country | US
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Telephone | 516-672-3830
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Fax | 516-706-0421
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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 | 001562
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License Number State | NY
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