MEDICARE: CATALINA ANGEL MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	085631-1	NY
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1215345574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATALINA ANGEL MA

Provider Business Mailing Address
First Line	:	5535 NETHERLAND AVE
Second Line	:	APT 4D
City	:	BRONX
State	:	NY
Zip	:	10471-2341
Country	:	US
Telephone Number	:	646-742-7716
Fax Number	:

Provider Business Practice Location Address
First Line	:	5535 NETHERLAND AVE
Second Line	:	APT 4D
City	:	BRONX
State	:	NY
Zip	:	10471-2341
Country	:	US
Telephone Number	:	646-742-7716
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2014
Last Update Date	:	06/21/2017

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