Provider Demographics
NPI:1063145662
Name:ANGELIESE, MIA CARINA (BS, MS)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:CARINA
Last Name:ANGELIESE
Suffix:
Gender:F
Credentials:BS, MS
Other - Prefix:
Other - First Name:MIA
Other - Middle Name:ANGELIESE
Other - Last Name:ROTUNNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2050 S ONEIDA ST STE 102
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-2428
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2050 S ONEIDA ST STE 102
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-2428
Practice Address - Country:US
Practice Address - Phone:720-633-9693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor