Provider Demographics
NPI:1508459868
Name:MANGUNO, JOSHUA MICHAEL (LCSW)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:MICHAEL
Last Name:MANGUNO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 N FLORIDA ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-1544
Mailing Address - Country:US
Mailing Address - Phone:985-900-1626
Mailing Address - Fax:985-867-1768
Practice Address - Street 1:1505 N FLORIDA ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-1544
Practice Address - Country:US
Practice Address - Phone:985-900-1626
Practice Address - Fax:985-867-1768
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA157671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical