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General NPI Number Information
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NPI Number | 1063384907
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Entity Type | Individual
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Provider Name | MICAELA MANGANELLO
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Gender | Female
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Dates
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Enumeration Date | 09/20/2025
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Last Update Date | 09/20/2025
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Provider Practice Location Address
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Address Line | 400 WESTERN AVE
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-1704
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Country | US
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Telephone | 207-292-1306
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Fax |
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Provider Business Mailing Address
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Address Line | 50 ADAMS ST APT 1
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City | BIDDEFORD
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State | ME
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Zip | 04005-2995
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Country | US
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Telephone |
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Fax |
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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 | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number | RN72898
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License Number State | ME
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