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NPI Code Detail

MEDICARE: JOSEPH DE MANGEONT PC

MEDICARE: JOSEPH DE MANGEONT PC
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
1101YA0400XAddiction (Substance Use Disorder) CounselorC0700304OH

General Provider Information

NPI Number : 1891966222
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSEPH DE MANGEONT PC
Provider Business Mailing Address
First Line : 104 SPINK ST
Second Line :
City : WOOSTER
State : OH
Zip : 44691-3652
Country : US
Telephone Number : 330-264-8498
Fax Number : 330-264-3777
Provider Business Practice Location Address
First Line : 104 SPINK ST
Second Line :
City : WOOSTER
State : OH
Zip : 44691-3652
Country : US
Telephone Number : 330-264-8498
Fax Number : 330-264-3777
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2008
Last Update Date : 03/13/2008

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