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General NPI Number Information
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NPI Number | 1013346170
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Entity Type | Individual
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Provider Name | MARCELLINO JOSEPH MANGANELLI III CERTIFIED SOCIAL WOR
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Gender | Male
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Dates
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Enumeration Date | 11/08/2013
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Last Update Date | 11/08/2013
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Provider Practice Location Address
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Address Line | 2009 BACHARACH BLVD
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City | ATLANTIC CITY
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State | NJ
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Zip | 08401-3003
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Country | US
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Telephone | 609-344-5714
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Fax | 609-345-0775
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Provider Business Mailing Address
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Address Line | 2009 BACHARACH BLVD
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City | ATLANTIC CITY
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State | NJ
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Zip | 08401-3003
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Country | US
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Telephone | 609-344-5714
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Fax | 609-345-0775
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 37CA00100800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 44SW00736700
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License Number State | NJ
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