Provider Demographics
NPI:1487332417
Name:ANG, CHARISSA (MFT)
Entity type:Individual
Prefix:MRS
First Name:CHARISSA
Middle Name:
Last Name:ANG
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 WASHINGTON ST STE 206
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-5538
Mailing Address - Country:US
Mailing Address - Phone:617-325-2993
Mailing Address - Fax:617-325-5618
Practice Address - Street 1:1100 WASHINGTON ST STE 206
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5538
Practice Address - Country:US
Practice Address - Phone:617-325-2993
Practice Address - Fax:617-325-5618
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor