Provider Demographics
NPI:1427268887
Name:BANGLE, MARTHA RITA
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:RITA
Last Name:BANGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 S LENZNER AVE
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-4880
Mailing Address - Country:US
Mailing Address - Phone:520-515-2935
Mailing Address - Fax:520-515-2941
Practice Address - Street 1:1045 S LENZNER AVE
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-4880
Practice Address - Country:US
Practice Address - Phone:520-515-2935
Practice Address - Fax:520-515-2941
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool