Healthcare Provider Details

I. General information

NPI: 1912233081
Provider Name (Legal Business Name): LORRAINE A. D'ANGELO PMH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 SENECA ST
WEST SENECA NY
14224-3433
US

IV. Provider business mailing address

3802 SENECA ST
WEST SENECA NY
14224-3433
US

V. Phone/Fax

Practice location:
  • Phone: 716-677-5418
  • Fax: 716-677-4240
Mailing address:
  • Phone: 716-677-5418
  • Fax: 716-677-4240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF400896
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: