Individual
CAROL A MANGINO
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
NPP
Contact information
Practice address
203 SUMMIT ST, BATAVIA, NY 14020-1613
(585) 344-3190
(585) 344-3235
Mailing address
203 SUMMIT ST, BATAVIA, NY 14020-1613
(585) 344-3190
(585) 344-3235
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F400776-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00026411401
UNIVERA
NY
01
—
000590237004
BLUE CROSS WNY
NY
05
—
02502418
—
NY
01
—
117633EU
PREFERRED CARE
NY
Enumeration date
03/23/2006
Last updated
07/08/2007
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