Provider Demographics
NPI:1649227703
Name:DR. KENNETH J. MANGES & ASSOCIATES, INC.
Entity Type:Organization
Organization Name:DR. KENNETH J. MANGES & ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:MANGES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:513-784-1333
Mailing Address - Street 1:810 SYCAMORE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-2155
Mailing Address - Country:US
Mailing Address - Phone:513-784-1333
Mailing Address - Fax:513-338-1920
Practice Address - Street 1:810 SYCAMORE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-2155
Practice Address - Country:US
Practice Address - Phone:513-784-1333
Practice Address - Fax:513-338-1920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3656103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0638859Medicaid
OHMACP31851Medicare PIN
OHDR9361421Medicare PIN