Provider Demographics
NPI:1114995289
Name:DEANGELIS, JOSEPH ANTHONY (LICSW)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:DEANGELIS
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4001
Mailing Address - Country:US
Mailing Address - Phone:781-862-6404
Mailing Address - Fax:781-862-2390
Practice Address - Street 1:109 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4001
Practice Address - Country:US
Practice Address - Phone:781-862-6404
Practice Address - Fax:781-862-2390
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10304251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP2215101Medicare UPIN