Provider Demographics
NPI:1407962673
Name:DEANGELO, DEBRA VINCETTA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:VINCETTA
Last Name:DEANGELO
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 1:843 BIG BEND DR
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-3806
Mailing Address - Country:US
Mailing Address - Phone:508-331-7367
Mailing Address - Fax:
Practice Address - Street 1:9 CEDAR ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2586
Practice Address - Country:US
Practice Address - Phone:508-331-7367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2019-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1134161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ16383ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER I.D.