Provider Demographics
NPI:1205081254
Name:ANGELUS THERAPEUTIC SERVICES INC
Entity type:Organization
Organization Name:ANGELUS THERAPEUTIC SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NESSA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW MSW MBA
Authorized Official - Phone:724-654-9555
Mailing Address - Street 1:401 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-2238
Mailing Address - Country:US
Mailing Address - Phone:724-654-9555
Mailing Address - Fax:724-498-0976
Practice Address - Street 1:401 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-2238
Practice Address - Country:US
Practice Address - Phone:724-654-9555
Practice Address - Fax:724-498-0976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 363LP0808X, 101YP2500X
PA893199971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102946000 0010Medicaid
PA102946000 0012Medicaid
PA102946000 0011Medicaid