Provider Demographics
NPI:1871065078
Name:ANGELO, KATELYN (LMFT)
Entity type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:
Last Name:ANGELO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 LOFT AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-3426
Mailing Address - Country:US
Mailing Address - Phone:516-672-3830
Mailing Address - Fax:516-706-0421
Practice Address - Street 1:120 W PARK AVE STE 312
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3301
Practice Address - Country:US
Practice Address - Phone:516-672-3830
Practice Address - Fax:516-706-0421
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-28
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001562106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist