MEDICARE: WILLIAM MANGANO

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA188083	OH

General Provider Information

NPI Number	:	1598590572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM MANGANO

Provider Business Mailing Address
First Line	:	17448 NORTHWOOD AVE
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-2210
Country	:	US
Telephone Number	:	216-217-5151
Fax Number	:

Provider Business Practice Location Address
First Line	:	17448 NORTHWOOD AVE
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-2210
Country	:	US
Telephone Number	:	216-217-5151
Fax Number	:

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

Provider Enumeration Date	:	09/07/2024
Last Update Date	:	09/07/2024

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Directions to “ WILLIAM MANGANO ” Practice Location

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