Provider Demographics
NPI:1215005673
Name:MANGIALETTI, NADA ROSE (PHD)
Entity Type:Individual
Prefix:DR
First Name:NADA
Middle Name:ROSE
Last Name:MANGIALETTI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-110 HANUA ST
Mailing Address - Street 2:#208A
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-1705
Mailing Address - Country:US
Mailing Address - Phone:808-682-5808
Mailing Address - Fax:808-682-5808
Practice Address - Street 1:91-110 HANUA ST
Practice Address - Street 2:#208A
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-1705
Practice Address - Country:US
Practice Address - Phone:808-682-5808
Practice Address - Fax:808-682-5808
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY307103TB0200X, 103TC0700X, 103TC2200X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI017588-02Medicaid
HI508654OtherHMA
HI017588-02OtherALOHA CARE QUEST
HI420425OtherVALUE OPTIONS
HI1413644OtherUNIVERSITY HEALTH ALLIANC
HI508654OtherHMA
HI017588-02Medicaid