Provider Demographics
NPI:1134795057
Name:DANGELO, JORDAN LYNN
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:LYNN
Last Name:DANGELO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:LYNN
Other - Last Name:MELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:87 MOUSE MILL RD
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:MA
Mailing Address - Zip Code:02790-4126
Mailing Address - Country:US
Mailing Address - Phone:774-222-1755
Mailing Address - Fax:
Practice Address - Street 1:1082 DAVOL ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-1124
Practice Address - Country:US
Practice Address - Phone:508-678-2833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor