Provider Demographics
NPI:1730694043
Name:MANGINI, GIOVANNINA MARIE
Entity type:Individual
Prefix:
First Name:GIOVANNINA
Middle Name:MARIE
Last Name:MANGINI
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 1:148 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3831
Mailing Address - Country:US
Mailing Address - Phone:802-356-2329
Mailing Address - Fax:
Practice Address - Street 1:148 CLARK ST # 3
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3831
Practice Address - Country:US
Practice Address - Phone:802-356-2329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health