Provider Demographics
NPI:1619415478
Name:MANGAN, CAROLYN S (LMHC)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:S
Last Name:MANGAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 VANDERBILT BEACH RD
Mailing Address - Street 2:SUITE 108-396
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-2654
Mailing Address - Country:US
Mailing Address - Phone:239-777-2454
Mailing Address - Fax:
Practice Address - Street 1:9915 TAMIAMI TRL N
Practice Address - Street 2:SUITE 2
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-1927
Practice Address - Country:US
Practice Address - Phone:239-777-2454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13836101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health