Individual
MATTHEW JON MANGIAPANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
200 HAWKINS AVE UNIT 41, RONKONKOMA, NY 11779-8002
(631) 604-8918
Mailing address
16 VALLEY ST, RONKONKOMA, NY 11779-1831
(516) 527-0947
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
001010
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001010
NYS LMFT
NY
Enumeration date
05/11/2016
Last updated
11/30/2023
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