Healthcare Provider Details

I. General information

NPI: 1740364868
Provider Name (Legal Business Name): AMY J. MANNING PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5035 OLD WILLIAM PENN HWY
EXPORT PA
15632-9348
US

IV. Provider business mailing address

405 MALLARD DR
CRANBERRY TOWNSHIP PA
16066-7609
US

V. Phone/Fax

Practice location:
  • Phone: 724-733-3491
  • Fax: 724-733-3498
Mailing address:
  • Phone: 412-327-1456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS009149L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: