Provider Demographics
NPI:1598822678
Name:D'ANGELO, RAYMOND ANTHONY (MA, LPC, NCC, CSMS)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:ANTHONY
Last Name:D'ANGELO
Suffix:
Gender:M
Credentials:MA, LPC, NCC, CSMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 263
Mailing Address - Street 2:
Mailing Address - City:BOYERS
Mailing Address - State:PA
Mailing Address - Zip Code:16020-0263
Mailing Address - Country:US
Mailing Address - Phone:724-735-4674
Mailing Address - Fax:724-735-4674
Practice Address - Street 1:2500 CANOE RIPPLE RD
Practice Address - Street 2:
Practice Address - City:SLIGO
Practice Address - State:PA
Practice Address - Zip Code:16255-1648
Practice Address - Country:US
Practice Address - Phone:814-358-2348
Practice Address - Fax:724-735-4674
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002798101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional