Provider Demographics
NPI:1598200701
Name:MANGANO, SUSAN (DNP PMHNP BOARD CERT)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:MANGANO
Suffix:
Gender:F
Credentials:DNP PMHNP BOARD CERT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 N MILL ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-2261
Mailing Address - Country:US
Mailing Address - Phone:630-646-8000
Mailing Address - Fax:630-646-6007
Practice Address - Street 1:1335 N MILL ST
Practice Address - Street 2:SUITE 100
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-2261
Practice Address - Country:US
Practice Address - Phone:630-404-3302
Practice Address - Fax:630-646-6007
Is Sole Proprietor?:No
Enumeration Date:2016-12-23
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015356363LP0808X
IL309010767363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health