Provider Demographics
NPI:1700108354
Name:MANGIE, CATHERINE C (LICSW)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:C
Last Name:MANGIE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 MAIN ST
Mailing Address - Street 2:44A
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-1658
Mailing Address - Country:US
Mailing Address - Phone:617-599-8007
Mailing Address - Fax:
Practice Address - Street 1:599 NORTH AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-1648
Practice Address - Country:US
Practice Address - Phone:781-246-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1117191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical