Provider Demographics
NPI:1053590943
Name:MANGINE, DANIEL REED (PHD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:REED
Last Name:MANGINE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1553 WOODCREST AVE
Mailing Address - Street 2:
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-3064
Mailing Address - Country:US
Mailing Address - Phone:412-716-3047
Mailing Address - Fax:
Practice Address - Street 1:39 WHITE AVE
Practice Address - Street 2:
Practice Address - City:CRAFTON
Practice Address - State:PA
Practice Address - Zip Code:15205-2847
Practice Address - Country:US
Practice Address - Phone:412-921-3050
Practice Address - Fax:412-922-3230
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016319103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical