Provider Demographics
NPI:1437811098
Name:DEANGELIS, DOMENICA (LCSW)
Entity type:Individual
Prefix:
First Name:DOMENICA
Middle Name:
Last Name:DEANGELIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1573 W FAIRBANKS AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4679
Mailing Address - Country:US
Mailing Address - Phone:407-896-8097
Mailing Address - Fax:407-898-8328
Practice Address - Street 1:1573 W FAIRBANKS AVE STE 100
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4679
Practice Address - Country:US
Practice Address - Phone:407-896-8097
Practice Address - Fax:407-898-8328
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12419-01104100000X
FLSW231131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker