Provider Demographics
NPI:1528865995
Name:DEANGELIS, BLAINE JAMIE
Entity type:Individual
Prefix:
First Name:BLAINE
Middle Name:JAMIE
Last Name:DEANGELIS
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 1:5 EBBTIDE CT
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-2271
Mailing Address - Country:US
Mailing Address - Phone:631-988-3727
Mailing Address - Fax:
Practice Address - Street 1:733 3RD AVE
Practice Address - Street 2:FLOOR 16 #1047
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-3224
Practice Address - Country:US
Practice Address - Phone:646-450-3064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist