Healthcare Provider Details

I. General information

NPI: 1730097379
Provider Name (Legal Business Name): ADONNA MARIA MANZO LCPC CONDITIONAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 WESTERN AVE
MANCHESTER ME
04351-3561
US

IV. Provider business mailing address

747 WESTERN AVE
MANCHESTER ME
04351-3561
US

V. Phone/Fax

Practice location:
  • Phone: 207-922-4600
  • Fax:
Mailing address:
  • Phone: 207-922-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberXL8943
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: