Provider Demographics
NPI:1053868059
Name:DEANGELIS, TAMARA (LCSW)
Entity type:Individual
Prefix:
First Name:TAMARA
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 1:6055 E WASHINGTON BLVD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-2449
Mailing Address - Country:US
Mailing Address - Phone:323-346-0960
Mailing Address - Fax:323-346-0966
Practice Address - Street 1:6055 E WASHINGTON BLVD
Practice Address - Street 2:SUITE 900
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-2449
Practice Address - Country:US
Practice Address - Phone:323-346-0960
Practice Address - Fax:323-346-0966
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2021-09-09
Deactivation Date:2021-07-29
Deactivation Code:
Reactivation Date:2021-08-25
Provider Licenses
StateLicense IDTaxonomies
225400000X
CA1002321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty