Provider Demographics
NPI:1558832931
Name:DANGELO, CAROL (LSW, MSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:DANGELO
Suffix:
Gender:F
Credentials:LSW, MSW
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW, MSW
Mailing Address - Street 1:517 DELTONA BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-8016
Mailing Address - Country:US
Mailing Address - Phone:386-259-5413
Mailing Address - Fax:
Practice Address - Street 1:517 DELTONA BLVD STE A
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-8016
Practice Address - Country:US
Practice Address - Phone:386-259-5413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL060267001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical