Healthcare Provider Details

I. General information

NPI: 1700981909
Provider Name (Legal Business Name): MICHAEL A MANGHERA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W BULLARD AVE SUITE F2
CLOVIS CA
93612
US

IV. Provider business mailing address

200 W BULLARD AVE STE F2
CLOVIS CA
93612-7611
US

V. Phone/Fax

Practice location:
  • Phone: 559-298-3717
  • Fax:
Mailing address:
  • Phone: 559-240-1489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 17833
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: