Provider Demographics
NPI:1184036261
Name:MANGLOS, CAROL LYNN (MA, LCPC, CWHE,)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:LYNN
Last Name:MANGLOS
Suffix:
Gender:F
Credentials:MA, LCPC, CWHE,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 STATE FAIR BLVD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13209-1312
Mailing Address - Country:US
Mailing Address - Phone:315-559-7128
Mailing Address - Fax:
Practice Address - Street 1:812 STATE FAIR BLVD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13209-1312
Practice Address - Country:US
Practice Address - Phone:315-559-7128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-23
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral