Provider Demographics
NPI:1346764248
Name:AYLI-MANGANIELO, ANTOINETTE (MA, LAC)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:AYLI-MANGANIELO
Suffix:
Gender:F
Credentials:MA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 BEACH ST
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-3513
Mailing Address - Country:US
Mailing Address - Phone:973-615-7230
Mailing Address - Fax:
Practice Address - Street 1:159 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-3507
Practice Address - Country:US
Practice Address - Phone:973-229-3198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health