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NPI Code Detail

MEDICARE: MS. SUSAN MARIE DEANGELO L.C.S.W.

MEDICARE: MS. SUSAN MARIE DEANGELO L.C.S.W.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker44SC00762600NJ

General Provider Information

NPI Number : 1518098094
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SUSAN MARIE DEANGELO L.C.S.W.
Provider Business Mailing Address
First Line : 126 FAIRVIEW AVE
Second Line :
City : BOGOTA
State : NJ
Zip : 07603-1810
Country : US
Telephone Number : 201-567-0500
Fax Number :
Provider Business Practice Location Address
First Line : 2 PARK AVE
Second Line :
City : DUMONT
State : NJ
Zip : 07628-3004
Country : US
Telephone Number : 201-385-4400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2007
Last Update Date : 07/08/2007

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