Provider Demographics
NPI:1285161141
Name:CILIBERTI, ANGELO ANTHONY II (MA, LPC, CGP)
Entity type:Individual
Prefix:
First Name:ANGELO
Middle Name:ANTHONY
Last Name:CILIBERTI
Suffix:II
Gender:M
Credentials:MA, LPC, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 CENTAUR CIR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2847
Mailing Address - Country:US
Mailing Address - Phone:303-949-5577
Mailing Address - Fax:
Practice Address - Street 1:331 MAXWELL AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3972
Practice Address - Country:US
Practice Address - Phone:303-949-5577
Practice Address - Fax:303-949-5577
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-22
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0005770101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO81-4601316OtherCOLORADO BUSINESS BUREAU