MEDICARE: ANGELUS THERAPEUTIC SERVICES INC

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
3	101YP2500X	Professional Counselor
4	1041C0700X	Clinical Social Worker	89319997	PA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1205081254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELUS THERAPEUTIC SERVICES INC

Provider Business Mailing Address
First Line	:	401 N JEFFERSON ST
Second Line	:
City	:	NEW CASTLE
State	:	PA
Zip	:	16101-2238
Country	:	US
Telephone Number	:	724-654-9555
Fax Number	:	724-498-0976

Provider Business Practice Location Address
First Line	:	401 N JEFFERSON ST
Second Line	:
City	:	NEW CASTLE
State	:	PA
Zip	:	16101-2238
Country	:	US
Telephone Number	:	724-654-9555
Fax Number	:	724-498-0976

Authorized Official
Title or Position	:	DIRECTOR
Name	:	NESSA L SMITH
Credential	:	LCSW MSW MBA
Telephone Number	:	724-654-9555

Provider Enumeration Date	:	11/18/2008
Last Update Date	:	06/13/2024

10 UNION SQ E , BETH ISRAEL MED CTR- DEPT OF REHAB MEDICARE
NEW YORK, NY
10003-3314

Practice Phone: 212-420-2757
Practice Fax: