MEDICARE: DR. RICHARD MANGEN PSY.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	103TC0700X	Clinical Psychologist	1126	CO

General Provider Information

NPI Number	:	1710207337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD MANGEN PSY.D.

Provider Business Mailing Address
First Line	:	6444 S QUEBEC ST
Second Line	:	SUITE 202
City	:	CENTENNIAL
State	:	CO
Zip	:	80111-7601
Country	:	US
Telephone Number	:	303-875-3297
Fax Number	:	303-721-8770

Provider Business Practice Location Address
First Line	:	6444 S QUEBEC ST
Second Line	:	SUITE 202
City	:	CENTENNIAL
State	:	CO
Zip	:	80111-7601
Country	:	US
Telephone Number	:	303-875-3297
Fax Number	:	303-721-8770

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

Provider Enumeration Date	:	06/05/2010
Last Update Date	:	06/05/2010

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