Provider Demographics
NPI:1972173623
Name:MANTOVANI, GEORGIE ANNE (MSW)
Entity Type:Individual
Prefix:
First Name:GEORGIE
Middle Name:ANNE
Last Name:MANTOVANI
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:672 BOHEMIA PKWY
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-3305
Mailing Address - Country:US
Mailing Address - Phone:631-664-5788
Mailing Address - Fax:
Practice Address - Street 1:475 E MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3121
Practice Address - Country:US
Practice Address - Phone:631-664-5788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker