Provider Demographics
NPI:1336219955
Name:CANGELLO, ANNE (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:
Last Name:CANGELLO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 MASSACHUSETTS AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-5001
Mailing Address - Country:US
Mailing Address - Phone:781-645-9998
Mailing Address - Fax:
Practice Address - Street 1:661 MASSACHUSETTS AVE STE 2
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-5001
Practice Address - Country:US
Practice Address - Phone:781-645-9998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10483103TC0700X, 103TC2200X
NY017234103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00354316Medicaid