MEDICARE: ANGELA SERRITELLA LCSW

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149.017541	IL

General Provider Information

NPI Number	:	1720494610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA SERRITELLA LCSW

Provider Business Mailing Address
First Line	:	3402 LANDSEND CT
Second Line	:
City	:	ISLAND LAKE
State	:	IL
Zip	:	60042-9732
Country	:	US
Telephone Number	:	847-714-4720
Fax Number	:

Provider Business Practice Location Address
First Line	:	3402 LANDSEND CT
Second Line	:
City	:	ISLAND LAKE
State	:	IL
Zip	:	60042-9732
Country	:	US
Telephone Number	:	847-714-4720
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2014
Last Update Date	:	12/12/2024

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