Healthcare Provider Details

I. General information

NPI: 1811779606
Provider Name (Legal Business Name): KATIE ANNE MANGANELLO PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. KATIE MANGANELLO

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HAVERFORD RD STE 205
HAVERFORD PA
19041-1139
US

IV. Provider business mailing address

390 COMMERCE DR
FORT WASHINGTON PA
19034-2600
US

V. Phone/Fax

Practice location:
  • Phone: 215-258-4172
  • Fax:
Mailing address:
  • Phone: 215-258-4172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS020013
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: