Provider Demographics
NPI:1629582705
Name:COLANGELO, FELICITY (LCSW)
Entity Type:Individual
Prefix:
First Name:FELICITY
Middle Name:
Last Name:COLANGELO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 BRIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2324
Mailing Address - Country:US
Mailing Address - Phone:207-387-1028
Mailing Address - Fax:207-560-9134
Practice Address - Street 1:602 BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-387-1028
Practice Address - Fax:207-560-9134
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-28
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC178301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical