MEDICARE: MS. CATHERINE C. MANGIE LICSW

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	1041C0700X	Clinical Social Worker	111719	MA

General Provider Information

NPI Number	:	1700108354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CATHERINE C. MANGIE LICSW

Provider Business Mailing Address
First Line	:	159 MAIN ST
Second Line	:	44A
City	:	STONEHAM
State	:	MA
Zip	:	02180-1658
Country	:	US
Telephone Number	:	617-599-8007
Fax Number	:

Provider Business Practice Location Address
First Line	:	599 NORTH AVE
Second Line	:	SUITE 8
City	:	WAKEFIELD
State	:	MA
Zip	:	01880-1648
Country	:	US
Telephone Number	:	781-246-8400
Fax Number	:

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

Provider Enumeration Date	:	02/24/2010
Last Update Date	:	02/24/2010

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