Provider Demographics
NPI:1467946194
Name:RASTELLI, ANGELINA LOUISE (BSW,CCSP)
Entity Type:Individual
Prefix:MS
First Name:ANGELINA
Middle Name:LOUISE
Last Name:RASTELLI
Suffix:
Gender:F
Credentials:BSW,CCSP
Other - Prefix:
Other - First Name:ANGELINA
Other - Middle Name:LOUISE
Other - Last Name:RASTELLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSW, CCSP
Mailing Address - Street 1:33 PERRY AVE
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-2417
Mailing Address - Country:US
Mailing Address - Phone:401-378-8347
Mailing Address - Fax:
Practice Address - Street 1:33 PERRY AVE
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2417
Practice Address - Country:US
Practice Address - Phone:401-378-8347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-16
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
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