Healthcare Provider Details

I. General information

NPI: 1679485288
Provider Name (Legal Business Name): MANIFEST THERAPY CO. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CANAL ST
LAWRENCE MA
01840-1420
US

IV. Provider business mailing address

300 CANAL ST
LAWRENCE MA
01840-1420
US

V. Phone/Fax

Practice location:
  • Phone: 978-701-1664
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MISS MONIQUE CROPPER
Title or Position: AUTHORIZED OFFICIAL
Credential: LMHC
Phone: 978-701-1664