Provider Demographics
NPI:1710076559
Name:MANGAN, REBECCA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:MANGAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:REBECCA
Other - Last Name:MANGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:5901 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90822-5201
Mailing Address - Country:US
Mailing Address - Phone:562-826-8000
Mailing Address - Fax:
Practice Address - Street 1:5353 E 2ND ST
Practice Address - Street 2:SUITE 203
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-5300
Practice Address - Country:US
Practice Address - Phone:562-400-4877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 123721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical