Provider Demographics
NPI:1588990204
Name:ANGELLO, DANIELLA ALICIA (LCSW)
Entity type:Individual
Prefix:MS
First Name:DANIELLA
Middle Name:ALICIA
Last Name:ANGELLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 N MAPLE AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3233
Mailing Address - Country:US
Mailing Address - Phone:201-410-4117
Mailing Address - Fax:
Practice Address - Street 1:65 N MAPLE AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3233
Practice Address - Country:US
Practice Address - Phone:201-410-4117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-30
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080271104100000X
NJ44SC055409001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker