Provider Demographics
NPI:1306961628
Name:MANCINELLI, MARY MARGARET (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:MARGARET
Last Name:MANCINELLI
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:MARGARET
Other - Last Name:MANCINELLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:2465 S DOWNING ST STE 110
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5822
Mailing Address - Country:US
Mailing Address - Phone:303-778-2513
Mailing Address - Fax:303-778-2436
Practice Address - Street 1:2465 S DOWNING ST STE 110
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5822
Practice Address - Country:US
Practice Address - Phone:303-778-2513
Practice Address - Fax:303-778-2436
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1235101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
38051320Medicare UPIN