Provider Demographics
NPI:1316967359
Name:DEANGELIS, GERALD (LCSW)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:
Last Name:DEANGELIS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 PROSPECT AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-4153
Mailing Address - Country:US
Mailing Address - Phone:973-731-6970
Mailing Address - Fax:973-731-3313
Practice Address - Street 1:470 PROSPECT AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-4153
Practice Address - Country:US
Practice Address - Phone:973-731-6970
Practice Address - Fax:973-731-3313
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC003101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ637812Medicare ID - Type Unspecified