Provider Demographics
NPI:1710175161
Name:FONTANEZ, ANGELICA (LCSW)
Entity type:Individual
Prefix:MISS
First Name:ANGELICA
Middle Name:
Last Name:FONTANEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 DAHLIA LN
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CT
Mailing Address - Zip Code:06896-1421
Mailing Address - Country:US
Mailing Address - Phone:203-948-4126
Mailing Address - Fax:203-612-9830
Practice Address - Street 1:35 KINGS HWY E
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-4873
Practice Address - Country:US
Practice Address - Phone:203-948-4126
Practice Address - Fax:203-612-9830
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0065131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical