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General NPI Number Information
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NPI Number | 1811779606
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Entity Type | Individual
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Provider Name | KATIE ANNE MANGANELLO PSYD
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Gender | Female
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Dates
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Enumeration Date | 10/17/2023
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 600 HAVERFORD RD STE 205
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City | HAVERFORD
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State | PA
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Zip | 19041-1139
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Country | US
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Telephone | 215-258-4172
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Fax |
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Provider Business Mailing Address
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Address Line | 390 COMMERCE DR
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City | FORT WASHINGTON
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State | PA
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Zip | 19034-2600
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Country | US
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Telephone | 215-258-4172
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS020013
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License Number State | PA
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