Provider Demographics
NPI:1184482689
Name:MANCINI, NEVAEH GABRIELLA
Entity type:Individual
Prefix:
First Name:NEVAEH
Middle Name:GABRIELLA
Last Name:MANCINI
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 1:824 CENTRAL AVE APT A
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-4627
Mailing Address - Country:US
Mailing Address - Phone:980-269-6092
Mailing Address - Fax:
Practice Address - Street 1:824 CENTRAL AVE APT A
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-4627
Practice Address - Country:US
Practice Address - Phone:980-269-6092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician