Provider Demographics
NPI:1932724986
Name:MANGAN, BRIAN (PSYD, ABPP)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:MANGAN
Suffix:
Gender:M
Credentials:PSYD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9960 NW 116TH WAY STE 12
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1175
Mailing Address - Country:US
Mailing Address - Phone:305-442-8800
Mailing Address - Fax:305-442-4469
Practice Address - Street 1:9960 NW 116TH WAY STE 12
Practice Address - Street 2:
Practice Address - City:MEDLEY
Practice Address - State:FL
Practice Address - Zip Code:33178-1175
Practice Address - Country:US
Practice Address - Phone:305-442-8800
Practice Address - Fax:305-442-4469
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7198103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic