Provider Demographics
NPI:1811779606
Name:MANGANELLO, KATIE ANNE (PSYD)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:ANNE
Last Name:MANGANELLO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:MANGANELLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:143 PENSDALE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19127-1611
Mailing Address - Country:US
Mailing Address - Phone:717-877-3097
Mailing Address - Fax:
Practice Address - Street 1:405 SILVERSIDE RD STE 204
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-1768
Practice Address - Country:US
Practice Address - Phone:717-877-3097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS020013103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical