MEDICARE: MR. JOSEPH DANGELO MSW LCSW

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
1	1041C0700X	Clinical Social Worker	SW3928	FL

General Provider Information

NPI Number	:	1578616736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH DANGELO MSW LCSW

Provider Business Mailing Address
First Line	:	1137 SE SABINA LN
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34983
Country	:	US
Telephone Number	:	772-398-1566
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 W MIDWAY RD
Second Line	:
City	:	FT PIERCE
State	:	FL
Zip	:	34981
Country	:	US
Telephone Number	:	772-467-3040
Fax Number	:	772-467-3048

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	07/08/2007

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