Provider Demographics
NPI:1265836266
Name:MANDERINO, DEVON (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEVON
Middle Name:
Last Name:MANDERINO
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 1:4160 WASHINGTON RD STE 209
Mailing Address - Street 2:
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2533
Mailing Address - Country:US
Mailing Address - Phone:724-797-1157
Mailing Address - Fax:
Practice Address - Street 1:4160 WASHINGTON RD STE 209
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2533
Practice Address - Country:US
Practice Address - Phone:724-797-1157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007266101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional