Provider Demographics
NPI:1174797500
Name:CAIAZZA, ANGELA M (LMFT)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:M
Last Name:CAIAZZA
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 1:123 E POWELL BLVD
Mailing Address - Street 2:SUITE #303
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7624
Mailing Address - Country:US
Mailing Address - Phone:503-516-8266
Mailing Address - Fax:
Practice Address - Street 1:123 E POWELL BLVD
Practice Address - Street 2:SUITE #303
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7624
Practice Address - Country:US
Practice Address - Phone:503-516-8266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01132106H00000X
ORT0828106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist