Mango, Lisa Marie
Mango, Lisa Marie is an sole proprietor health care provider with primary practice located at 2222 Colonial Rd Ste 100 , Fort Pierce FL 34950-5309. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder). Behavioral Health & Social Service Providers / Mental Health is her primary health care specialty. Mango, Lisa Marie can be contacted via phone (772) 489-4726.Contact Information
Primary practice address
2222 Colonial Rd Ste 100
Fort Pierce FL 34950-5309
Phone: (772) 489-4726
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | CAP3115 | Florida |
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | 101YM0800X | Florida |
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | CAP3115 | Florida |
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | 101YM0800X |
Profile Details
| NPI number | 1649819699 |
|---|---|
| LBN Legal business name | Mango, Lisa Marie |
| Credentials | MS. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 21st, 2019 |
| Last updated | May 10th, 2022 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1649819699 | NPPES |
| Florida | MEDICAID | 101YM0800X |
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