Provider Demographics
NPI:1497493712
Name:DEANGELIS, JON R (LCAT)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:R
Last Name:DEANGELIS
Suffix:
Gender:M
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 LUM AVE
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2320
Mailing Address - Country:US
Mailing Address - Phone:973-879-3887
Mailing Address - Fax:
Practice Address - Street 1:7 LUM AVE
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2320
Practice Address - Country:US
Practice Address - Phone:973-879-3887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2529-01101200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101200000XBehavioral Health & Social Service ProvidersDrama Therapist