Provider Demographics
NPI:1477787976
Name:MANGION, MELANIE L (MSW LICSW)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:L
Last Name:MANGION
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BUTTERNUT LN
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-5621
Mailing Address - Country:US
Mailing Address - Phone:978-994-0190
Mailing Address - Fax:
Practice Address - Street 1:60 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6207
Practice Address - Country:US
Practice Address - Phone:978-521-7777
Practice Address - Fax:978-521-7767
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1312294Medicaid