Provider Demographics
NPI:1164199618
Name:TAMARA DE ANGELIS LICENSED CLINICAL SOCIAL WORKER, INC.
Entity Type:Organization
Organization Name:TAMARA DE ANGELIS LICENSED CLINICAL SOCIAL WORKER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEANGELIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:609-338-2244
Mailing Address - Street 1:2272 COLORADO BLVD STE 1164
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-1143
Mailing Address - Country:US
Mailing Address - Phone:323-925-5279
Mailing Address - Fax:
Practice Address - Street 1:2272 COLORADO BLVD STE 1164
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-1143
Practice Address - Country:US
Practice Address - Phone:323-925-5279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRYSALIS CLINICAL SOCIAL WORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty