Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PSY20354 | CA |
N | 103TC0700X | Clinical Psychologist | PSY20354 | CA |
Y | 103G00000X | Clinical Psychologist | PY60351579 | WA |
Y | 103TC0700X | Clinical Psychologist | PY60351579 | WA |
NPI | 1003006966 |
---|---|
Provider Name | Dr. Michael Anthony D'angelo JR. |
First Address | Tacoma, WA 98431-0001 |
Second Address | Tacoma, WA 98431-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2007 |
Last Update Date | 06/08/2020 |