Provider Demographics
NPI:1932122660
Name:COLANGELO, AMY (LICSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:COLANGELO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 SALISBURY ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1121
Mailing Address - Country:US
Mailing Address - Phone:508-755-3101
Mailing Address - Fax:508-755-7460
Practice Address - Street 1:646 SALISBURY ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1121
Practice Address - Country:US
Practice Address - Phone:508-755-7553
Practice Address - Fax:508-755-7460
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10230251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP06967Medicare ID - Type Unspecified