MEDICARE: MR. TODD JOSEPH MANGINI MA COUNSELING PSYCH

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	106H00000X	Marriage & Family Therapist	50202	CA

General Provider Information

NPI Number	:	1225195985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TODD JOSEPH MANGINI MA COUNSELING PSYCH

Provider Business Mailing Address
First Line	:	1470 17TH AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-3403
Country	:	US
Telephone Number	:	415-513-9123
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 EXECUTIVE PARK BLVD
Second Line	:	4900
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94134-3306
Country	:	US
Telephone Number	:	415-513-9123
Fax Number	:

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

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	09/30/2009

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