MEDICARE: MS. CRYSTAL MANCO LMHC

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	101YM0800X	Mental Health Counselor	MHC00666	RI

General Provider Information

NPI Number	:	1891054177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CRYSTAL MANCO LMHC

Provider Business Mailing Address
First Line	:	15 FLEMING RD
Second Line	:
City	:	CRANSTON
State	:	RI
Zip	:	02920-3057
Country	:	US
Telephone Number	:	401-462-2300
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 FLEMING RD
Second Line	:
City	:	CRANSTON
State	:	RI
Zip	:	02920-3057
Country	:	US
Telephone Number	:	401-462-0000
Fax Number	:

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

Provider Enumeration Date	:	05/08/2012
Last Update Date	:	01/02/2026

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