Doctor Name: | MS. SUSAN L MANGOLD |
NPI Number: | 1972860518 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC, NCC |
License Number: | PC005400 |
Business Practice Address: | 85 Noble St Kutztown, PA - 195301713 |
Business Phone Number: | 4849555679 |
Business Fax Number: | 4846469172 |
Mailing Address: | 85 Noble St, KUTZTOWN |
State: | PA |
Postal Code: | 195301713 |
Phone Number: | 4849555679 |
Fax Number: | 4846469172 |
NPI Enumeration Date: | 04/20/2012 |
NPI Last Update Date: | 04/20/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | PC005400 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |