Provider Demographics
NPI:1023265865
Name:MANGINE, STEVEN JOSEPH (PHD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:JOSEPH
Last Name:MANGINE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 REGENCY CIR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2348
Mailing Address - Country:US
Mailing Address - Phone:859-277-2844
Mailing Address - Fax:
Practice Address - Street 1:261 REGENCY CIR
Practice Address - Street 2:SUITE 3
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2348
Practice Address - Country:US
Practice Address - Phone:859-277-2844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-23
Last Update Date:2008-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY847103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist