Provider Demographics
NPI:1902640642
Name:PIATEK, ANGELINE (RBT)
Entity type:Individual
Prefix:
First Name:ANGELINE
Middle Name:
Last Name:PIATEK
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7027 CAMINO DEGRAZIA UNIT 208
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-7811
Mailing Address - Country:US
Mailing Address - Phone:619-727-3926
Mailing Address - Fax:
Practice Address - Street 1:7027 CAMINO DEGRAZIA UNIT 208
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-7811
Practice Address - Country:US
Practice Address - Phone:619-727-3926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-24-354482106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician