Provider Demographics
NPI:1811660178
Name:MUNGO, FLORENCE SISANG
Entity type:Individual
Prefix:
First Name:FLORENCE
Middle Name:SISANG
Last Name:MUNGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6724 RISING SUN AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-4629
Mailing Address - Country:US
Mailing Address - Phone:215-214-5941
Mailing Address - Fax:
Practice Address - Street 1:6724 RISING SUN AVE FL 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-4629
Practice Address - Country:US
Practice Address - Phone:215-214-5941
Practice Address - Fax:215-214-5941
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-31
Last Update Date:2021-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011220101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC011220OtherBOARD OF SOCIAL WORKER AND PROFESSIONAL COUNSELOR