Provider Demographics
NPI:1831870732
Name:ANGELELLI, KATIE (LSW)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:ANGELELLI
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CARNATION LN
Mailing Address - Street 2:
Mailing Address - City:MILL HALL
Mailing Address - State:PA
Mailing Address - Zip Code:17751-9034
Mailing Address - Country:US
Mailing Address - Phone:607-425-4481
Mailing Address - Fax:
Practice Address - Street 1:705 WASHINGTON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-5355
Practice Address - Country:US
Practice Address - Phone:570-321-6390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW140520104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker