Healthcare Provider Details

I. General information

NPI: 1740067339
Provider Name (Legal Business Name): NICOLE DEANGELIS MS, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 TAXTER RD STE 640
ELMSFORD NY
10523-2361
US

IV. Provider business mailing address

570 TAXTER RD STE 640
ELMSFORD NY
10523-2361
US

V. Phone/Fax

Practice location:
  • Phone: 631-371-2974
  • Fax:
Mailing address:
  • Phone: 631-371-2974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number015132
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: