Healthcare Provider Details

I. General information

NPI: 1174271621
Provider Name (Legal Business Name): VICTORIA DANGELO LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 03/14/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 W SKIPPACK PIKE UNIT F
SKIPPACK PA
19474
US

IV. Provider business mailing address

550 W B ST FL 4
SAN DIEGO CA
92101-3537
US

V. Phone/Fax

Practice location:
  • Phone: 215-500-1179
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW138097
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: