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NPI Code Detail

MEDICARE: CATHERINE MARA ANGLEN CATC II

MEDICARE: CATHERINE MARA ANGLEN CATC II
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
1101YA0400XAddiction (Substance Use Disorder) CounselorRI- A0702240356CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17182OTHERCACADTP

General Provider Information

NPI Number : 1700018066
Entity Type Code : Individual
Provider Name (Legal Business Name) : CATHERINE MARA ANGLEN CATC II
Provider Business Mailing Address
First Line : 7000B S CENTER DR
Second Line :
City : CLEARLAKE
State : CA
Zip : 95422-8131
Country : US
Telephone Number : 707-994-7090
Fax Number : 707-994-7164
Provider Business Practice Location Address
First Line : 201 BRUSH ST
Second Line :
City : UKIAH
State : CA
Zip : 95482-3424
Country : US
Telephone Number : 707-462-6290
Fax Number : 707-468-6427
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2009
Last Update Date : 09/19/2018

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Directions to “ CATHERINE MARA ANGLEN CATC II” Practice Location

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