Healthcare Provider Details

I. General information

NPI: 1265836266
Provider Name (Legal Business Name): DEVON MANDERINO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 WASHINGTON RD STE 209
MC MURRAY PA
15317-2533
US

IV. Provider business mailing address

4160 WASHINGTON RD STE 209
MC MURRAY PA
15317-2533
US

V. Phone/Fax

Practice location:
  • Phone: 724-797-1157
  • Fax:
Mailing address:
  • Phone: 724-797-1157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC007266
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: