Provider Demographics
NPI:1720136286
Name:MANGOLD, ANNE MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:MARIE
Last Name:MANGOLD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 HOUSTON RD
Mailing Address - Street 2:BLDG. 300, SUITE 29
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-4873
Mailing Address - Country:US
Mailing Address - Phone:859-746-9272
Mailing Address - Fax:859-746-9322
Practice Address - Street 1:7000 HOUSTON RD
Practice Address - Street 2:BLDG. 300, SUITE 29
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4873
Practice Address - Country:US
Practice Address - Phone:859-746-9272
Practice Address - Fax:859-746-9322
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY09841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0651002Medicare ID - Type Unspecified