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Lisa Marie Mango, MS
Mental Health Counselor in Fort Pierce, Florida
NPI 1649819699

Lisa Marie Mango is a Mental Health Counselor based in Palm Beach Gardens, FL and is specialized in Mental Health. Lisa Marie Mango practices in Fort Pierce, FL and has the professional credentials of MS. The NPI Number for Lisa Marie Mango is 1649819699 and holds a License No. CAP3115 (Florida).

The current practice location address for Lisa Marie Mango is 2222 Colonial Rd Ste 100, Fort Pierce, FL and can be reached out via phone at 772-489-4726.

Location: 2222 Colonial Rd Ste 100, Fort Pierce, FL, 33412-1110
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1649819699
Provider Name
Lisa Marie Mango
Credential
MS
Provider Entity Type
Individual
Gender
Female
Address
2222 Colonial Rd Ste 100, Fort Pierce, FL, 33412-1110
Phone Number
772-489-4726
Fax Number
Provider Enumeration Date
12/21/2019
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
101YM0800X 05 FL
institution
Provider Business Practice Location Address Details
Address
2222 Colonial Rd Ste 100
City
Fort Pierce
State
Florida
Zip
34950-5309
Phone Number
772-489-4726
Fax Number
person
Provider Business Mailing Address Details
Address
2222 Colonial Rd Ste 100
City
Fort Pierce
State
Florida
Zip
34950-5309
Phone Number
772-489-4726
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
101YA0400X
License No.
101YM0800X (Florida)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
101YM0800X
License No.
CAP3115 (Florida)
Definition
Definition to come...
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