Provider Demographics
NPI:1194553891
Name:CARANGELO, DONNA (LADC)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:CARANGELO
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:GRAVEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:52 ORCHARD LN
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716-2012
Mailing Address - Country:US
Mailing Address - Phone:203-910-5981
Mailing Address - Fax:
Practice Address - Street 1:1776 MERIDEN RD
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716-3341
Practice Address - Country:US
Practice Address - Phone:203-910-5981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1569101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)