Provider Demographics
NPI:1063644821
Name:MANGIARDI, EUGENE (LCSW)
Entity type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:
Last Name:MANGIARDI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 N STAR ST APT 15
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-1886
Mailing Address - Country:US
Mailing Address - Phone:907-345-0158
Mailing Address - Fax:
Practice Address - Street 1:2220 N STAR ST APT 15
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-1886
Practice Address - Country:US
Practice Address - Phone:907-345-0158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA00781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical