Provider Demographics
NPI:1811132517
Name:DEANGELIS, JODI ERIN (MA, LCDP)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:ERIN
Last Name:DEANGELIS
Suffix:
Gender:F
Credentials:MA, LCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 N MAIN ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5762
Mailing Address - Country:US
Mailing Address - Phone:401-437-8243
Mailing Address - Fax:401-276-6102
Practice Address - Street 1:530 N MAIN ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5762
Practice Address - Country:US
Practice Address - Phone:401-437-8243
Practice Address - Fax:401-276-6102
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIC179101Y00000X
RICDP00594101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIC179OtherCOUNSELOR CERTIFICATE STATE OF RHODE ISLAND