Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 1690 | MA |
Y | 103T00000X | Psychologist | 1690 | MA |
NPI | 1003997073 |
---|---|
Provider Name | Dr. James A. Manganiello |
First Address | Groveland, MA 01834-1001 |
Second Address | Essex, MA 01929-1040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 08/07/2007 |