Provider Demographics
NPI:1316110141
Name:PACHECO, ANGEL ENRIQUE (PHD, CPSYCH)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:ENRIQUE
Last Name:PACHECO
Suffix:
Gender:M
Credentials:PHD, CPSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 INDER HEIGHTS DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRAMPTON
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L6Z 3N5
Mailing Address - Country:CA
Mailing Address - Phone:647-701-6715
Mailing Address - Fax:905-970-1333
Practice Address - Street 1:2680 MATHESON BOULEVARD EAST, SUITE 102
Practice Address - Street 2:
Practice Address - City:MISSISSAUGA
Practice Address - State:ONTARIO
Practice Address - Zip Code:L4W 0A5
Practice Address - Country:CA
Practice Address - Phone:647-701-6715
Practice Address - Fax:905-970-1333
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-13
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 5395103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist