Provider Demographics
NPI:1255579405
Name:MANCINI, JASON (LMSW)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:MANCINI
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-2524
Mailing Address - Country:US
Mailing Address - Phone:607-584-4474
Mailing Address - Fax:607-584-4480
Practice Address - Street 1:303 MAIN ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-2524
Practice Address - Country:US
Practice Address - Phone:607-584-4474
Practice Address - Fax:607-584-4480
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077147104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker