Provider Demographics
NPI:1972603157
Name:MASTRANTUONO, ANGELA (LCSW-R)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MASTRANTUONO
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:MASTERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:954 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-2247
Mailing Address - Country:US
Mailing Address - Phone:845-489-1491
Mailing Address - Fax:
Practice Address - Street 1:230 NORTH RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1328
Practice Address - Country:US
Practice Address - Phone:845-485-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059251-11041C0700X
NY0759191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNE1860Medicare ID - Type UnspecifiedPROVIDER NUMBER