Provider Demographics
NPI:1851454938
Name:MANGANELLO, JAMES ANGELO (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ANGELO
Last Name:MANGANELLO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9 GRAPEVINE AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-7062
Mailing Address - Country:US
Mailing Address - Phone:781-863-0350
Mailing Address - Fax:781-674-2450
Practice Address - Street 1:9 GRAPEVINE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-7062
Practice Address - Country:US
Practice Address - Phone:781-863-0350
Practice Address - Fax:781-674-2450
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPY3212PR103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service