Provider Demographics
NPI:1215308689
Name:MANGIONE, MARIA D (PSYD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:D
Last Name:MANGIONE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8585 E HARTFORD DR STE 107
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-5472
Mailing Address - Country:US
Mailing Address - Phone:480-800-7591
Mailing Address - Fax:
Practice Address - Street 1:4835 E CACTUS RD STE 333
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-3542
Practice Address - Country:US
Practice Address - Phone:480-840-7267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-12
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-005028103TC0700X
225C00000X
VA0810005700103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor