Provider Demographics
NPI:1316113533
Name:MANGANARO, JENNIPHER LYNNE (MSW)
Entity type:Individual
Prefix:MRS
First Name:JENNIPHER
Middle Name:LYNNE
Last Name:MANGANARO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 9TH AVE
Mailing Address - Street 2:MAIL STOP 359760
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2499
Mailing Address - Country:US
Mailing Address - Phone:206-744-4363
Mailing Address - Fax:206-744-8274
Practice Address - Street 1:325 9TH AVE
Practice Address - Street 2:MAIL STOP 359760
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2499
Practice Address - Country:US
Practice Address - Phone:206-744-4363
Practice Address - Fax:206-744-8274
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00058956104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker