MEDICARE: ANGELA LUCY BABADJANIAN

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	103TC0700X	Clinical Psychologist	6135	CO

General Provider Information

NPI Number	:	1659854818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA LUCY BABADJANIAN

Provider Business Mailing Address
First Line	:	3230 E WOODMEN RD STE 110
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-8502
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3595 E FOUNTAIN BLVD STE 130
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-1734
Country	:	US
Telephone Number	:	719-623-2356
Fax Number	:

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

Provider Enumeration Date	:	09/12/2018
Last Update Date	:	08/08/2023

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