Basic Information
| Provider Information | |||||||||
| NPI: | 1912233081 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | D'ANGELO | ||||||||
| FirstName: | LORRAINE | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | PMH NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3802 SENECA ST | ||||||||
| Address2: | |||||||||
| City: | WEST SENECA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142243433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166775418 | ||||||||
| FaxNumber: | 7166774240 | ||||||||
| Practice Location | |||||||||
| Address1: | 3802 SENECA ST | ||||||||
| Address2: | |||||||||
| City: | WEST SENECA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142243433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166775418 | ||||||||
| FaxNumber: | 7166774240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2009 | ||||||||
| LastUpdateDate: | 11/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | F400896 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 03281734 | 05 | NY | MEDICAID |