Angela Didomenico
Individual provider Active NPI Social Worker · Roscoe, IL
NPI 1821743352 · NPPES record last updated Feb 14, 2022
Key facts
- NPI
- 1821743352
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- 150006528 (IL)
- Practice address
- 5290 Williams Dr
Roscoe, IL 61073-9222 - Phone
- (815) 324-0324
- NPI assigned
- Feb 14, 2022
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 150006528 | IL | MD | Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 150006528 | IL | Yes |
Addresses
Primary practice location
5290 Williams Dr
Roscoe, IL 61073-9222
Mailing address
7247 Mabels Way
Loves Park, IL 61111-5373
Phone (815) 222-7986
Other providers in Roscoe, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 14, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.