Provider Demographics
NPI:1609334317
Name:D'ANGELO, RISA
Entity Type:Individual
Prefix:MS
First Name:RISA
Middle Name:
Last Name:D'ANGELO
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 1:24 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-2820
Mailing Address - Country:US
Mailing Address - Phone:201-819-6631
Mailing Address - Fax:
Practice Address - Street 1:24 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:NORTH HALEDON
Practice Address - State:NJ
Practice Address - Zip Code:07508-2820
Practice Address - Country:US
Practice Address - Phone:201-819-6631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services