Provider Demographics
NPI:1437370343
Name:MANGIERE, JEANNETTE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JEANNETTE
Middle Name:
Last Name:MANGIERE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3518 214TH PL
Mailing Address - Street 2:APT. 2
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-1722
Mailing Address - Country:US
Mailing Address - Phone:718-281-0349
Mailing Address - Fax:
Practice Address - Street 1:3909 214TH PL
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2123
Practice Address - Country:US
Practice Address - Phone:718-229-5757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039176-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03668QMedicare ID - Type Unspecified