Provider Demographics
NPI:1669866315
Name:MANCINONE, JOSEPH (LMFT)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:MANCINONE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 SOUTHBURY RD
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06783-2101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:271 SOUTHBURY RD
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:CT
Practice Address - Zip Code:06783-2101
Practice Address - Country:US
Practice Address - Phone:203-788-5119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001202322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children