Healthcare Provider Details

I. General information

NPI: 1770080129
Provider Name (Legal Business Name): VANESSA MANN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5884 CIUDAD LEON CT
SAN DIEGO CA
92120-3965
US

IV. Provider business mailing address

902 S MYRTLE AVE
MONROVIA CA
91016-3427
US

V. Phone/Fax

Practice location:
  • Phone: 909-230-8106
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number81359
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number81359
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number131200
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: