Provider Demographics
NPI:1679706881
Name:RETANO, ANGELA (RN, MA,MSN, PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:RETANO
Suffix:
Gender:F
Credentials:RN, MA,MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 CENTRAL PARK W OFC 12
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4198
Mailing Address - Country:US
Mailing Address - Phone:212-228-3970
Mailing Address - Fax:
Practice Address - Street 1:115 CENTRAL PARK W OFC 12
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4198
Practice Address - Country:US
Practice Address - Phone:212-228-3970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR13466100163W00000X
NY576684-1163W00000X
NYF401201-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse