Provider Demographics
NPI:1881412872
Name:DORINE D'ANGELO, LCSW
Entity type:Organization
Organization Name:DORINE D'ANGELO, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DORINE
Authorized Official - Middle Name:
Authorized Official - Last Name:D'ANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-974-0858
Mailing Address - Street 1:631 MONTAUK HWY STE 6
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4400
Mailing Address - Country:US
Mailing Address - Phone:631-974-0858
Mailing Address - Fax:
Practice Address - Street 1:631 MONTAUK HWY STE 6
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4400
Practice Address - Country:US
Practice Address - Phone:631-974-0858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-30
Last Update Date:2024-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health