1811909401 NPI number — MR. ANGELO M. FARENGA LPC

Table of content: MR. ANGELO M. FARENGA LPC (NPI 1811909401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811909401 NPI number — MR. ANGELO M. FARENGA LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARENGA
Provider First Name:
ANGELO
Provider Middle Name:
M.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811909401
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 186
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERTOWN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06795-0186
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-417-2006
Provider Business Mailing Address Fax Number:
860-730-6225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 SIEMON COMPANY DR
Provider Second Line Business Practice Location Address:
SUITE 310W
Provider Business Practice Location Address City Name:
WATERTOWN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06795-2654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-417-2005
Provider Business Practice Location Address Fax Number:
860-730-6225
Provider Enumeration Date:
08/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  000118 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com