Provider Demographics
NPI:1275797524
Name:MANGARELLI, PATRICIA ANN (NPP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:MANGARELLI
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CRITTENDEN BLVD
Mailing Address - Street 2:BOX PSYCH
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-273-2320
Mailing Address - Fax:585-560-1860
Practice Address - Street 1:300 CRITTENDEN BLVD
Practice Address - Street 2:BOX PSYCH
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-273-2320
Practice Address - Fax:585-560-1860
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401132363LP0808X
NYF4011321363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health