Provider Demographics
NPI:1427423748
Name:MANGIARDI, MARIA (LCPC)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MANGIARDI
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34220 N BLUESTEM RD
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-5245
Mailing Address - Country:US
Mailing Address - Phone:847-942-8789
Mailing Address - Fax:
Practice Address - Street 1:185 HERITAGE DR STE 1B
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-8059
Practice Address - Country:US
Practice Address - Phone:815-477-4727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-11
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-013347101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional