Individual provider · Type 1 NPI

Angelina Koesnodihardjo

Mental Health Counselor · San Carlos, CA

NPI number 1225322175 Active

Practice location

957 Industrial Rd, Suite B
San Carlos, CA 94070-4151

Fax (650) 620-9549

Mailing address

PO Box 70
Redwood City, CA 94064-0070

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XNone listed

Mental Health Counselor: Definition to come...

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About NPI 1225322175

Angelina Koesnodihardjo's National Provider Identifier is 1225322175, issued on Jun 7, 2011. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in San Carlos, CA. The record was last updated on Jul 29, 2015.