Provider Demographics
NPI:1376955393
Name:SERRAVALLE, ANGELA (PSYD, LPCMH, NCC)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:SERRAVALLE
Suffix:
Gender:F
Credentials:PSYD, LPCMH, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5879 SUMMIT BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:DE
Mailing Address - Zip Code:19734-9375
Mailing Address - Country:US
Mailing Address - Phone:302-608-3780
Mailing Address - Fax:302-355-3226
Practice Address - Street 1:5879 SUMMIT BRIDGE RD
Practice Address - Street 2:
Practice Address - City:TOWNSEND
Practice Address - State:DE
Practice Address - Zip Code:19734-9375
Practice Address - Country:US
Practice Address - Phone:302-608-3780
Practice Address - Fax:302-355-3226
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-26
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000607101YM0800X
DEB1-0011250103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health