Provider Demographics
NPI:1477024172
Name:MANGLANI, NISHA CATHERINE THAYIL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:NISHA
Middle Name:CATHERINE THAYIL
Last Name:MANGLANI
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 1:22 BONAVENTURE AVE
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-2104
Mailing Address - Country:US
Mailing Address - Phone:914-602-1003
Mailing Address - Fax:
Practice Address - Street 1:22 BONAVENTURE AVE
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-2104
Practice Address - Country:US
Practice Address - Phone:914-602-1003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0876931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical