Provider Demographics
NPI:1871946251
Name:CONGDON, ANGELA (LMFT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:CONGDON
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 1:1190 S BASCOM AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3545
Mailing Address - Country:US
Mailing Address - Phone:408-234-1405
Mailing Address - Fax:
Practice Address - Street 1:1190 S BASCOM AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3545
Practice Address - Country:US
Practice Address - Phone:408-234-1405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49930101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health