Provider Demographics
NPI:1811909401
Name:FARENGA, ANGELO M (LPC)
Entity type:Individual
Prefix:MR
First Name:ANGELO
Middle Name:M
Last Name:FARENGA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-0186
Mailing Address - Country:US
Mailing Address - Phone:860-417-2006
Mailing Address - Fax:860-730-6225
Practice Address - Street 1:27 SIEMON COMPANY DR
Practice Address - Street 2:SUITE 310W
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-2654
Practice Address - Country:US
Practice Address - Phone:860-417-2005
Practice Address - Fax:860-730-6225
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000118101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health