Provider Information for 1174829469
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Ms. STACY M MANDATO MSSA, LSW
Sex: Female
NPI: 1174829469
Last Updated: 2022-03-28
Certification Date: 2022-03-28
Certification Date: 2022-03-28
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1174829469 | ||||||||||||||
| Enumeration Date | 2011-02-03 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | NO | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | PO BOX 932909 CLEVELAND, OH 44193-2909 United States Phone: 330-825-1152 | Fax:330-854-0829 | ||||||||||||||
| Primary Practice Address | 1302 W MAIN ST STE A LOUISVILLE, OH 44641-1114 United States Phone: 330-875-5544 | Fax:330-875-8150 | ||||||||||||||
| Secondary Practice Address(es) | 8445 MUNSON RD | ||||||||||||||
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