MEDICARE: DR. KENNETH J. MANGES PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	3656	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104879394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH J. MANGES PH.D.

Provider Business Mailing Address
First Line	:	810 SYCAMORE ST
Second Line	:	SUITE 100
City	:	CINCINNATI
State	:	OH
Zip	:	45202-2156
Country	:	US
Telephone Number	:	513-784-1333
Fax Number	:	513-338-1920

Provider Business Practice Location Address
First Line	:	810 SYCAMORE ST
Second Line	:	SUITE 100
City	:	CINCINNATI
State	:	OH
Zip	:	45202-2156
Country	:	US
Telephone Number	:	513-784-1333
Fax Number	:	513-338-1920

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	11/16/2010

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