Provider Demographics
NPI:1841631439
Name:FEDINEC, ANGELA RENATA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:RENATA
Last Name:FEDINEC
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:RENATA
Other - Last Name:AGNOLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2603 S WASHINGTON ST
Mailing Address - Street 2:SUITE 170
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-6370
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2603 S WASHINGTON ST
Practice Address - Street 2:SUITE 170
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-6370
Practice Address - Country:US
Practice Address - Phone:630-973-8857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490148311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical