Provider Demographics
NPI:1780037747
Name:MANGIAMELI, JOHNMARK (MSW)
Entity Type:Individual
Prefix:
First Name:JOHNMARK
Middle Name:
Last Name:MANGIAMELI
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 DECATUR AVE
Mailing Address - Street 2:PAT 52B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-2915
Mailing Address - Country:US
Mailing Address - Phone:845-282-9833
Mailing Address - Fax:
Practice Address - Street 1:2860 DECATUR AVE
Practice Address - Street 2:PAT 52B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-2915
Practice Address - Country:US
Practice Address - Phone:845-282-9833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical