MEDICARE: LAURA MCMANUS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW12900	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326406521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MCMANUS LCSW

Provider Business Mailing Address
First Line	:	PO BOX 15092
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32406-5092
Country	:	US
Telephone Number	:	850-596-2569
Fax Number	:	850-248-2469

Provider Business Practice Location Address
First Line	:	924 W 13TH ST
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-2214
Country	:	US
Telephone Number	:	850-596-2569
Fax Number	:	850-248-2469

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2016
Last Update Date	:	08/26/2016

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Directions to “ LAURA MCMANUS LCSW” Practice Location

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