Provider Demographics
NPI:1245876390
Name:VASSALLO, ANGELA
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:VASSALLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 GLEN BERNE DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19804-3409
Mailing Address - Country:US
Mailing Address - Phone:302-723-1924
Mailing Address - Fax:
Practice Address - Street 1:205 GLEN BERNE DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19804-3409
Practice Address - Country:US
Practice Address - Phone:302-723-1924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health