Provider Demographics
NPI:1518189315
Name:MWANGI, BENEDICT K (EDD)
Entity Type:Individual
Prefix:DR
First Name:BENEDICT
Middle Name:K
Last Name:MWANGI
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 TOLMA AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15216
Mailing Address - Country:US
Mailing Address - Phone:412-638-6971
Mailing Address - Fax:
Practice Address - Street 1:339 HAYMAKER
Practice Address - Street 2:1104
Practice Address - City:MONOREVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146
Practice Address - Country:US
Practice Address - Phone:412-372-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004070101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA11653935OtherCAQH