Provider Demographics
NPI:1790239325
Name:MANGIERI, DEANNA
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:MANGIERI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 CONGRESS ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-3564
Mailing Address - Country:US
Mailing Address - Phone:413-739-1611
Mailing Address - Fax:413-739-1711
Practice Address - Street 1:80 CONGRESS ST
Practice Address - Street 2:SUITE 106
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3564
Practice Address - Country:US
Practice Address - Phone:413-739-1611
Practice Address - Fax:413-739-1711
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health