Provider Demographics
NPI:1457968935
Name:D'ANGELO, DOMINIC JOSEPH (MA)
Entity Type:Individual
Prefix:MR
First Name:DOMINIC
Middle Name:JOSEPH
Last Name:D'ANGELO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2116
Mailing Address - Country:US
Mailing Address - Phone:610-717-2356
Mailing Address - Fax:
Practice Address - Street 1:987 OLD EAGLE SCHOOL RD STE 719
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-1708
Practice Address - Country:US
Practice Address - Phone:610-999-6414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional