Provider Demographics
NPI:1386951093
Name:DALESSIO, ANGELA
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:DALESSIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-3816
Mailing Address - Country:US
Mailing Address - Phone:508-485-0312
Mailing Address - Fax:508-753-5051
Practice Address - Street 1:31 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3816
Practice Address - Country:US
Practice Address - Phone:508-485-0312
Practice Address - Fax:508-753-5051
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1308785Medicaid
MA1002900OtherBEACON
MA1306421OtherMBHP
MAM18684OtherBLUE CROSS BLUE SHEILD
MA1306421Medicaid
MA690527OtherBLUE CROSS
MA690527OtherTUFTS
MA690527OtherBLUE CROSS