Healthcare Provider Details

I. General information

NPI: 1649227703
Provider Name (Legal Business Name): DR. KENNETH J. MANGES & ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 SYCAMORE ST SUITE 100
CINCINNATI OH
45202-2155
US

IV. Provider business mailing address

810 SYCAMORE ST SUITE 100
CINCINNATI OH
45202-2155
US

V. Phone/Fax

Practice location:
  • Phone: 513-784-1333
  • Fax: 513-338-1920
Mailing address:
  • Phone: 513-784-1333
  • Fax: 513-338-1920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3656
License Number StateOH

VIII. Authorized Official

Name: DR. KENNETH J. MANGES
Title or Position: OWNER
Credential: PHD
Phone: 513-784-1333