Provider Demographics
NPI:1689852790
Name:D'ANGELO, MICHAEL P
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:D'ANGELO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MIKE
Other - Middle Name:
Other - Last Name:DANGELO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:1489 BALTIMORE PIKE
Mailing Address - Street 2:BLDG. 200, SUITE 250
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-3958
Mailing Address - Country:US
Mailing Address - Phone:610-544-2110
Mailing Address - Fax:
Practice Address - Street 1:1489 BALTIMORE PIKE
Practice Address - Street 2:BLDG. 200, SUITE 250
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-3958
Practice Address - Country:US
Practice Address - Phone:610-544-2110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004752101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional