Healthcare Provider Details

I. General information

NPI: 1003751504
Provider Name (Legal Business Name): CAMILLA J MANHEIMER
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 S RIVER ST STE 234A
SANTA CRUZ CA
95060-4556
US

IV. Provider business mailing address

PO BOX 398
SANTA CRUZ CA
95061-0398
US

V. Phone/Fax

Practice location:
  • Phone: 831-234-2010
  • Fax: 831-226-2123
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT155687
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: