Healthcare Provider Details

I. General information

NPI: 1831027374
Provider Name (Legal Business Name): LAVONDA MANUEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 LAFAYETTE BLVD STE 100
BRIDGEPORT CT
06604-4725
US

IV. Provider business mailing address

515 WEST AVE APT 406
BRIDGEPORT CT
06604-3949
US

V. Phone/Fax

Practice location:
  • Phone: 203-513-9456
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: