Healthcare Provider Details

I. General information

NPI: 1194837898
Provider Name (Legal Business Name): JESSICA S MANNING L.I.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 01/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3047 E MAIN RD SUITE 7B
PORTSMOUTH RI
02871-4263
US

IV. Provider business mailing address

PO BOX 671
PORTSMOUTH RI
02871-0671
US

V. Phone/Fax

Practice location:
  • Phone: 401-935-9041
  • Fax: 401-683-0753
Mailing address:
  • Phone: 401-935-9041
  • Fax: 401-683-0753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW01902
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: