Provider Demographics
NPI:1629268990
Name:MANGANO, RICHARD (MA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:MANGANO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4218 GREENSPIRE LN
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:PA
Mailing Address - Zip Code:18938-2302
Mailing Address - Country:US
Mailing Address - Phone:215-514-4062
Mailing Address - Fax:
Practice Address - Street 1:940 W KING RD
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-3166
Practice Address - Country:US
Practice Address - Phone:610-647-0330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-006800-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical