Healthcare Provider Details

I. General information

NPI: 1225983117
Provider Name (Legal Business Name): ANGELIQUE GENTES PORRECA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7344 S DUPONT HWY STE 6
FELTON DE
19943-5715
US

IV. Provider business mailing address

63 CAPTAIN DAVIS DR
CAMDEN DE
19934-1752
US

V. Phone/Fax

Practice location:
  • Phone: 302-212-4873
  • Fax:
Mailing address:
  • Phone: 302-480-2431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0012939
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: