Provider Demographics
NPI:1891669735
Name:MANGLES, SHERENE
Entity type:Individual
Prefix:
First Name:SHERENE
Middle Name:
Last Name:MANGLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 PORTION RD STE 12
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-2256
Mailing Address - Country:US
Mailing Address - Phone:631-320-1599
Mailing Address - Fax:
Practice Address - Street 1:1075 PORTION RD STE 12
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-2256
Practice Address - Country:US
Practice Address - Phone:631-320-1599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor