Provider Demographics
NPI:1760686596
Name:JOSEPH DEANGELIS LICSW LLC
Entity Type:Organization
Organization Name:JOSEPH DEANGELIS LICSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DEANGELIS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:978-851-4468
Mailing Address - Street 1:1565 MAIN ST
Mailing Address - Street 2:BLDG 2, SUITE 200
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-2085
Mailing Address - Country:US
Mailing Address - Phone:978-851-4468
Mailing Address - Fax:978-851-5561
Practice Address - Street 1:1565 MAIN ST
Practice Address - Street 2:BLDG 2, SUITE 200
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-2085
Practice Address - Country:US
Practice Address - Phone:978-851-4468
Practice Address - Fax:978-851-5561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10304251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP22151Medicare ID - Type Unspecified