Provider Demographics
NPI:1962546523
Name:DEANGELIS, DEANNA (LCSW)
Entity type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:
Last Name:DEANGELIS
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 1:190 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4432
Mailing Address - Country:US
Mailing Address - Phone:716-479-9302
Mailing Address - Fax:
Practice Address - Street 1:190 KINGS HWY
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:NY
Practice Address - Zip Code:14226-4432
Practice Address - Country:US
Practice Address - Phone:716-479-9302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081951-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health