Provider Demographics
NPI:1710790126
Name:DEGENOVA, ANGELA (LCMHC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:DEGENOVA
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 MANCHESTER ROAD
Mailing Address - Street 2:SUITE 11A #113
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038
Mailing Address - Country:US
Mailing Address - Phone:203-767-1553
Mailing Address - Fax:
Practice Address - Street 1:3 DERRY WAY APT 34
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-2158
Practice Address - Country:US
Practice Address - Phone:203-767-1553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4887101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor