Individual
DIA DEANGELIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
470 PROSPECT AVE STE 207, WEST ORANGE, NJ 07052-4106
(973) 738-7404
Mailing address
8 DEPAOLO CT, ROSELAND, NJ 07068-3711
(973) 738-7404
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
44SC05827100
NJ
1041C0700X
Clinical Social Worker
Primary
44SC05827100
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1041C0700X
—
NJ
Enumeration date
03/25/2019
Last updated
03/25/2019
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