Provider Demographics
NPI:1447572284
Name:ANGELO, DORINDA MARY (RN, LPC)
Entity Type:Individual
Prefix:MRS
First Name:DORINDA
Middle Name:MARY
Last Name:ANGELO
Suffix:
Gender:F
Credentials:RN, LPC
Other - Prefix:MISS
Other - First Name:DORINDA
Other - Middle Name:MARY
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:44 MURRAY AVE
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-3027
Mailing Address - Country:US
Mailing Address - Phone:201-891-5163
Mailing Address - Fax:
Practice Address - Street 1:61 N MAPLE AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3255
Practice Address - Country:US
Practice Address - Phone:201-788-3773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00401900101YP2500X
NJ26NR07181600163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No163W00000XNursing Service ProvidersRegistered Nurse