Provider Demographics
NPI:1164690228
Name:MANDIGO, CAROL L (LICSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:L
Last Name:MANDIGO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3761
Mailing Address - Country:US
Mailing Address - Phone:603-228-3862
Mailing Address - Fax:603-226-0073
Practice Address - Street 1:6 S STATE ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3761
Practice Address - Country:US
Practice Address - Phone:603-228-3862
Practice Address - Fax:603-226-0073
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical