Provider Demographics
NPI:1295315323
Name:SWEET MANGO THERAPY GROUP, LICENSED CLINICAL SOCIAL WORKER, INC.
Entity type:Organization
Organization Name:SWEET MANGO THERAPY GROUP, LICENSED CLINICAL SOCIAL WORKER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE ANN
Authorized Official - Middle Name:RAMOS
Authorized Official - Last Name:MELENDRES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:925-665-3668
Mailing Address - Street 1:11040 BOLLINGER CANYON RD STE E-439
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-4969
Mailing Address - Country:US
Mailing Address - Phone:925-665-3668
Mailing Address - Fax:
Practice Address - Street 1:11040 BOLLINGER CANYON RD STE E-439
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-4969
Practice Address - Country:US
Practice Address - Phone:925-665-3668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-13
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty