Provider Demographics
NPI:1649403189
Name:ANGELINE, ELEANOR MAE (LPC)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:MAE
Last Name:ANGELINE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1871 ROUTE 70 E
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2020
Mailing Address - Country:US
Mailing Address - Phone:856-751-8700
Mailing Address - Fax:857-751-3520
Practice Address - Street 1:1871 ROUTE 70 E
Practice Address - Street 2:SUITE 202
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2020
Practice Address - Country:US
Practice Address - Phone:856-751-8700
Practice Address - Fax:857-751-3520
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00387700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional