Provider Demographics
NPI:1356013866
Name:MANTZAS, AGNIESZKA MAGDALENA (LCPC, CEAP)
Entity Type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:MAGDALENA
Last Name:MANTZAS
Suffix:
Gender:F
Credentials:LCPC, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 N RIVER ROAD 3B
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056
Mailing Address - Country:US
Mailing Address - Phone:224-542-9900
Mailing Address - Fax:
Practice Address - Street 1:132 W LAKE STREET #7
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108
Practice Address - Country:US
Practice Address - Phone:224-542-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-03
Last Update Date:2021-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional