Provider Demographics
NPI:1164625141
Name:DEANGELO, LAURIE LEE (MA EDS)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:LEE
Last Name:DEANGELO
Suffix:
Gender:F
Credentials:MA EDS
Other - Prefix:MRS
Other - First Name:LAURIE
Other - Middle Name:LEE
Other - Last Name:FRISCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2908 NOTTINGHAM WAY
Mailing Address - Street 2:
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08619
Mailing Address - Country:US
Mailing Address - Phone:609-977-3814
Mailing Address - Fax:
Practice Address - Street 1:2908 NOTTINGHAM WAY
Practice Address - Street 2:
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619
Practice Address - Country:US
Practice Address - Phone:609-977-3814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00001300101Y00000X
NJ37LC00132400101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor