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General NPI Number Information
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NPI Number | 1487837605
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Entity Type | Individual
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Provider Name | RENAE S DEANGELO L.M.S.W.
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Gender | Female
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 04/04/2008
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Provider Practice Location Address
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Address Line | 1801 6TH AVE
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City | TROY
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State | NY
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Zip | 12180-3400
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Country | US
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Telephone | 518-274-5143
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Fax | 518-273-1350
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Provider Business Mailing Address
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Address Line | PO BOX 31094
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City | HARTFORD
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State | CT
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Zip | 06150-1094
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Country | US
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Telephone | 518-952-8140
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Fax | 518-952-8287
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 052204
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License Number State | NY
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