Healthcare Provider Details

I. General information

NPI: 1942936224
Provider Name (Legal Business Name): MERCEDES MANSO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 NORTH ST
MIDDLETOWN NY
10940-4704
US

IV. Provider business mailing address

305 NORTH ST
MIDDLETOWN NY
10940-4704
US

V. Phone/Fax

Practice location:
  • Phone: 845-343-7675
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: