Angelina Koesnodihardjo

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

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

Phone

(415) 941-1751

Fax

(650) 620-9549

NPI assigned

Jun 7, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1307404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438128000000",
    "number": "1225322175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "940640070",
            "telephone_number": "650-260-5041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "957 INDUSTRIAL RD",
            "address_2": "SUITE B",
            "city": "SAN CARLOS",
            "state": "CA",
            "postal_code": "940704151",
            "telephone_number": "415-941-1751",
            "fax_number": "650-620-9549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOESNODIHARDJO",
        "first_name": "ANGELINA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-07",
        "last_updated": "2015-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aleksandr Klebaner, DDS
• Marianna Klebanov, MFT AND LPCC
• William Andrew Klieves Sr.
• Crystal Necole Klingele
• R. B. Kniskern, PH.D., L.AC., O.M.D.
• Nichole Kohake
• Benjamin Kong
• Cheryl Ann Koskinen, ACSW
• Kalina Kotseva, MSCA, OTR/L
• Kotzan Chiropractic

• Mental Health Counselor in San Carlos, CA
• Providers in San Carlos, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.