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General NPI Number Information
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NPI Number | 1902826563
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Entity Type | Individual
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Provider Name | ELLEN COLANGELO PH.D.
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Gender | Female
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 10/18/2010
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Provider Practice Location Address
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Address Line | 3180 UNIVERSITY AVENUE SUITE 210
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City | SAN DIEGO
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State | CA
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Zip | 92104-2045
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Country | US
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Telephone | 619-807-5431
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Fax | 619-291-3441
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Provider Business Mailing Address
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Address Line | 3957 30TH STREET #517
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City | SAN DIEGO
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State | CA
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Zip | 92104-3085
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Country | US
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Telephone | 619-807-5431
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Fax | 619-291-3441
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY14129
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License Number State | CA
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