Healthcare Provider Details

I. General information

NPI: 1174903801
Provider Name (Legal Business Name): KEVIN MANCINI LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 BARBARA LOOP SE STE E1
RIO RANCHO NM
87124-1068
US

IV. Provider business mailing address

3901 GEORGIA ST NE STE A4
ALBUQUERQUE NM
87110-1391
US

V. Phone/Fax

Practice location:
  • Phone: 505-891-1583
  • Fax: 505-891-1768
Mailing address:
  • Phone: 505-891-1583
  • Fax: 505-891-1768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberCMF0188181
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCMF0188181
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: