Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 0810005700 | VA |
Y | 103TC0700X | Clinical Psychologist | 0810005700 | VA |
N | 103G00000X | Clinical Psychologist | PSY-005028 | AZ |
N | 103TC0700X | Clinical Psychologist | PSY-005028 | AZ |
N | 225C00000X | Rehabilitation Counselor |
NPI | 1215308689 |
---|---|
Provider Name | Maria D Mangione |
First Address | Scottsdale, AZ 85255-5472 |
Second Address | Scottsdale, AZ 85254-3542 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2015 |
Last Update Date | 09/09/2019 |