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General NPI Number Information
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NPI Number | 1346386869
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Entity Type | Individual
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Provider Name | ELIZABETH MANGUM LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 02/08/2019
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Provider Practice Location Address
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Address Line | 371 8TH ST
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City | BROOKLYN
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State | NY
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Zip | 11215-3604
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Country | US
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Telephone | 512-534-8425
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Fax |
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Provider Business Mailing Address
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Address Line | 196 ST. MARK'S AVE
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City | BROOKLYN
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State | NY
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Zip | 11238
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Country | US
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Telephone | 917-414-5595
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 059443
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 076115
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License Number State | NY
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