Provider Demographics
NPI:1114774148
Name:DEANGELIS PSYCHOLOGY PLLC
Entity type:Organization
Organization Name:DEANGELIS PSYCHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEANGELIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-778-0208
Mailing Address - Street 1:7978 RIVER RUN DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-4801
Mailing Address - Country:US
Mailing Address - Phone:734-778-0208
Mailing Address - Fax:
Practice Address - Street 1:2311 SHELBY AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-3849
Practice Address - Country:US
Practice Address - Phone:734-619-0456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty