Healthcare Provider Details

I. General information

NPI: 1255972774
Provider Name (Legal Business Name): GINA MANGONE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2019
Last Update Date: 09/28/2024
Certification Date: 09/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 STORY RD
EXPORT PA
15632-2666
US

IV. Provider business mailing address

4262 OLD WILLIAM PENN HWY STE 200
MURRYSVILLE PA
15668-1954
US

V. Phone/Fax

Practice location:
  • Phone: 412-668-4444
  • Fax:
Mailing address:
  • Phone: 410-668-4444
  • Fax: 724-468-0039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC010887
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: