Healthcare Provider Details

I. General information

NPI: 1255589115
Provider Name (Legal Business Name): DEANNE MASTRANGELO MSS, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 RUSSELL RD
PAOLI PA
19301-1236
US

IV. Provider business mailing address

1440 RUSSELL RD
PAOLI PA
19301-1236
US

V. Phone/Fax

Practice location:
  • Phone: 610-644-6464
  • Fax: 610-644-4066
Mailing address:
  • Phone: 610-644-6464
  • Fax: 610-644-4066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL05492500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: