Provider Demographics
NPI:1356435093
Name:MANGAN, GAIL M (PHD)
Entity type:Individual
Prefix:DR
First Name:GAIL
Middle Name:M
Last Name:MANGAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 FREDERICK AVE
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-1523
Mailing Address - Country:US
Mailing Address - Phone:412-741-4087
Mailing Address - Fax:412-741-6808
Practice Address - Street 1:424 FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-1523
Practice Address - Country:US
Practice Address - Phone:412-741-4087
Practice Address - Fax:412-741-6808
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008769103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000028065OtherBLUE CROSS BLUE SHIELD
PA1025743530001Medicaid