MEDICARE: SHAWN MANGO LCSW

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	5239-S	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5239-S	OTHER	NV	NEVADA STATE BOARD OF EXAMINERS FOR SOCIAL WORKERS

General Provider Information

NPI Number	:	1710371513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN MANGO LCSW

Provider Business Mailing Address
First Line	:	730 W CHEYENNE AVE
Second Line	:	SUITE 60
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7848
Country	:	US
Telephone Number	:	702-258-0031
Fax Number	:	702-221-0103

Provider Business Practice Location Address
First Line	:	730 W CHEYENNE AVE
Second Line	:	SUITE 60
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7848
Country	:	US
Telephone Number	:	702-258-0031
Fax Number	:	702-221-0103

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

Provider Enumeration Date	:	03/19/2015
Last Update Date	:	03/19/2015

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Directions to “ SHAWN MANGO LCSW” Practice Location

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