Provider Demographics
NPI:1124284005
Name:COLANGELO, JESSICA KATE (MSW, LICSW)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:KATE
Last Name:COLANGELO
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 GREEN RD
Mailing Address - Street 2:
Mailing Address - City:BOLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01740-1045
Mailing Address - Country:US
Mailing Address - Phone:978-758-1806
Mailing Address - Fax:
Practice Address - Street 1:141 GREEN RD
Practice Address - Street 2:
Practice Address - City:BOLTON
Practice Address - State:MA
Practice Address - Zip Code:01740-1045
Practice Address - Country:US
Practice Address - Phone:978-758-1806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1166451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical