Provider Demographics
NPI:1710489935
Name:DEANGELIS, MAUREEN LYN (LICSW)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:LYN
Last Name:DEANGELIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 KATHERINE DR
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NH
Mailing Address - Zip Code:03858-3521
Mailing Address - Country:US
Mailing Address - Phone:978-807-9735
Mailing Address - Fax:
Practice Address - Street 1:ROBERT FROST ELEMENTARY SCHOOL
Practice Address - Street 2:33 HAMLET STREET
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843
Practice Address - Country:US
Practice Address - Phone:978-722-8803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-03
Last Update Date:2018-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1102681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical