1275659161 NPI number — CAROLINE CANGELOSI LCSW

Table of content: CAROLINE CANGELOSI LCSW (NPI 1275659161)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275659161 NPI number — CAROLINE CANGELOSI LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANGELOSI
Provider First Name:
CAROLINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275659161
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2344 6TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERKELEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94710-2412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-981-4100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
837 ADDISON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-981-4100
Provider Business Practice Location Address Fax Number:
510-981-4294
Provider Enumeration Date:
03/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  ASW 21976 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 26700 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11260 . This is a "CBHS INTERNAL USE ONLY-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 132084 . This is a "CHN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 11260 . This is a "SFGH INTERNAL USE ONLY" identifier . This identifiers is of the category "OTHER".




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