Provider Demographics
NPI:1164994679
Name:FUCCI, ANGELA J (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:J
Last Name:FUCCI
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 1:102 ORIOLE CT
Mailing Address - Street 2:
Mailing Address - City:HAWLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18428-7774
Mailing Address - Country:US
Mailing Address - Phone:570-561-3583
Mailing Address - Fax:
Practice Address - Street 1:102 ORIOLE CT
Practice Address - Street 2:
Practice Address - City:HAWLEY
Practice Address - State:PA
Practice Address - Zip Code:18428-7774
Practice Address - Country:US
Practice Address - Phone:570-807-8212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-21
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103554-1104100000X
PASW133514104100000X
NJ44SC060476001041C0700X
PABH003272251S00000X, 251S00000X
PACW0221881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No251S00000XAgenciesCommunity/Behavioral Health