Provider Demographics
NPI:1770045064
Name:DEANGELIS, CHESTER ANTHONY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CHESTER
Middle Name:ANTHONY
Last Name:DEANGELIS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13620 HALLELUIAH TRL
Mailing Address - Street 2:
Mailing Address - City:ELBERT
Mailing Address - State:CO
Mailing Address - Zip Code:80106-9020
Mailing Address - Country:US
Mailing Address - Phone:719-495-3908
Mailing Address - Fax:719-494-1689
Practice Address - Street 1:13620 HALLELUIAH TRL
Practice Address - Street 2:
Practice Address - City:ELBERT
Practice Address - State:CO
Practice Address - Zip Code:80106-9020
Practice Address - Country:US
Practice Address - Phone:718-495-3908
Practice Address - Fax:719-494-1689
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO99258271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical