Provider Demographics
NPI:1497420327
Name:FACCHINEI, ANGELA L
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:L
Last Name:FACCHINEI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 PARK PL W
Mailing Address - Street 2:
Mailing Address - City:SHIPPENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17257-9212
Mailing Address - Country:US
Mailing Address - Phone:717-372-7409
Mailing Address - Fax:
Practice Address - Street 1:5006 E TRINDLE RD STE 101
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-3647
Practice Address - Country:US
Practice Address - Phone:717-243-1326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC013480101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional