Provider Demographics
NPI:1306374871
Name:D'ANGELO, LORI LYNN (PHD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LYNN
Last Name:D'ANGELO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11101 MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1813
Mailing Address - Country:US
Mailing Address - Phone:1216721-303-0133
Mailing Address - Fax:
Practice Address - Street 1:11101 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1813
Practice Address - Country:US
Practice Address - Phone:1216721-303-0133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5185103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical