Provider Demographics
NPI:1841526761
Name:MANGANO, ROBERTA (MS MSW LPC)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:MANGANO
Suffix:
Gender:F
Credentials:MS MSW LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 N MCLEAN ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:IL
Mailing Address - Zip Code:62656-2847
Mailing Address - Country:US
Mailing Address - Phone:217-671-7063
Mailing Address - Fax:
Practice Address - Street 1:204 N MCLEAN ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-2847
Practice Address - Country:US
Practice Address - Phone:217-671-7063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.004073101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor