Provider Demographics
NPI:1225195985
Name:MANGINI, TODD JOSEPH (MA COUNSELING PSYCH)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:JOSEPH
Last Name:MANGINI
Suffix:
Gender:M
Credentials:MA COUNSELING PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-3403
Mailing Address - Country:US
Mailing Address - Phone:415-513-9123
Mailing Address - Fax:
Practice Address - Street 1:250 EXECUTIVE PARK BLVD
Practice Address - Street 2:4900
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94134-3306
Practice Address - Country:US
Practice Address - Phone:415-513-9123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50202106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist