Provider Demographics
NPI:1649340597
Name:ANGELO, JANICE CECILE (MSW ,LCSW-R)
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:CECILE
Last Name:ANGELO
Suffix:
Gender:F
Credentials:MSW ,LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 BLUFFS DR N
Mailing Address - Street 2:
Mailing Address - City:CALVERTON
Mailing Address - State:NY
Mailing Address - Zip Code:11933-1299
Mailing Address - Country:US
Mailing Address - Phone:631-298-5376
Mailing Address - Fax:
Practice Address - Street 1:13000 MAIN RD
Practice Address - Street 2:
Practice Address - City:MATTITUCK
Practice Address - State:NY
Practice Address - Zip Code:11952-3206
Practice Address - Country:US
Practice Address - Phone:631-298-5376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR048242-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNO1551Medicare ID - Type Unspecified