Provider Demographics
NPI:1265751978
Name:MANGETTE, CHRISTINE N (0801131 LSW)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:N
Last Name:MANGETTE
Suffix:
Gender:F
Credentials:0801131 LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 ODNR MOHICAN 51
Mailing Address - Street 2:
Mailing Address - City:PERRYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44864-9407
Mailing Address - Country:US
Mailing Address - Phone:419-994-0300
Mailing Address - Fax:419-994-0305
Practice Address - Street 1:1012 ODNR MOHICAN 51
Practice Address - Street 2:
Practice Address - City:PERRYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44864-9407
Practice Address - Country:US
Practice Address - Phone:419-994-0300
Practice Address - Fax:419-994-0305
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0801131101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health