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General NPI Number Information
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NPI Number | 1568338291
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Entity Type | Individual
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Provider Name | JOHN MANGO
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Gender | Male
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Dates
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Enumeration Date | 10/10/2025
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 125 COLLEGE ST STE 5
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City | BURLINGTON
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State | VT
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Zip | 05401-8444
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Country | US
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Telephone | 802-391-4554
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Fax |
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Provider Business Mailing Address
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Address Line | 46 WEBSTER ST APT 1
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City | BARRE
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State | VT
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Zip | 05641-4350
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Country | US
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Telephone | 860-810-0609
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 097.0136265
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License Number State | VT
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