| Doctor Name: | GINA MARIE ANGILLETTA |
| NPI Number: | 1851759823 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMHC |
| License Number: | 006176 |
| Business Practice Address: | 34 Miller Rd Ballston Lake, NY - 120191004 |
| Business Phone Number: | 5182895555 |
| Business Fax Number: | |
| Mailing Address: | 30e Picotte Dr, ALBANY |
| State: | NY |
| Postal Code: | 122081760 |
| Phone Number: | 5185055673 |
| Fax Number: | |
| NPI Enumeration Date: | 02/05/2016 |
| NPI Last Update Date: | 02/05/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 006176 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |